Hackensack Meridian Health and the Carrier Clinic are using their combined resources to advance telepsychiatry.

HMH has reached more than 5,000 patients through telemedicine over the past two years and according to Chief Executive Officer Robert Garrett, that population is expected to grow as more doctors are connected to electronic medical records.

“In the last two years 15 percent of our doctors are using telehealth and I think that number is going to at least double over the next year to 18 months. In addition to the physician practices, we are using telehealth in other settings including community hospitals and urgent care centers,” said Garrett.

But it’s the behavioral health piece that Garrett sees as a big issue where there are shortages of specialists in psychiatry.

“We think that the urgent care is going to be a real game changer for us. In our community hospitals we are using telehealth for psychiatric consultations,” Garrett said.

Cost effectiveness

While it is a little early to assess the cost savings, Garrett said they could be significant. For example, for someone in a community hospital who needs a psychiatric consultation or needs access to a specialist, telepsychiatry can expedite the patients care.

“We can help patients get care faster. They don’t have to wait as long to connect with an expert. Additionally, by reducing length of stay you are going to have a significant cost reduction. If you are able to direct patients to urgent care centers where they can get a telemedicine/telepsychiatry consult, it’s a less expensive setting than an emergency room. We are going to be tracking this, I think there is going to be huge savings,” Garrett said.

The Carrier Clinic has been using an internal telesphychiatry system for four years and it is used by the entire clinical staff for continuity of care with patients, said President Donald Parker.

“If you’re off duty and your patient has an issue, we can bring you in by telepsychiatry for a consult. We use it for after hours for surges that we get in our emergency room where the clinician on duty may be seeing multiple patients. We bring in extra resources through the telepsychiatry system,” Parker said.

He added that he is particularly interested, now that Carrier is part of the HMH system, to take that capability and expand it with the psychiatrists in the Carrier system and reduce the workload of the psychiatrists who are part of the telepsychiatry system.

“But more importantly bring a greater degree of expertise available to psychiatrists and to emergency room doctors, hospitalists throughout the system with the level of expertise that we have within our psychiatric manpower,” Parker said.

The response from patients who have access to their doctors via telepsychiatry has been “extraordinary” he said, because they lock in with a single doctor at the Carrier Clinic and they have access to that doctor after hours and on the weekends.

Parker said telepsychiatry makes it possible for psychiatric specialists to be more widely available across Carrier’s clinical platform.

“We will expand the availability of the expertise that we have at Carrier Clinic and the expertise at Hackensack Meridian. Between the two of us we have an extraordinary number of psychiatrists all willing to use telepsychiatry,” said Parker.

Emotions meter

The Carrier Clinic is planning a pilot project in which telepsychiatry is enhanced by facial recognition software. Cameras are embedded in the telepsychiatry screen and they take what are called microelement facial expressions of the patient.

We don’t take the diagnosis away from the psychiatrist, the psychiatrist has a more narrow corridor where they can ask questions specific to validate that disease.
– Donald Parker, Carrier Clinic president

Those are expressions that are less than half a second long and are correlated with a bank of more than one million facial expressions that are organized by disease state.

Next the camera takes the picture,  queries the data bank, matches up the image and feeds back to the psychiatrist a percentage of possibilities that the patient’s facial expressions are correlated with a specific disease.

“We don’t take the diagnosis away from the psychiatrist, the psychiatrist has a more narrow corridor where they can ask questions specific to validate that disease,” Parker explained.

“We have an emotions meter that we’re working on. The emotions meter will be organized by ethnicity and it will allow us to dial up the particular ethnicity of the patient to more accurately interpret the facial expressions.

“It will help us overcome different types of cultures where facial expressions might not be commonly understood or by a psychiatrist who may be from a different ethnic background,” he said.

Garrett argued that telepsychiatry can enhance the quality of care because it is a cost-effective tool that will ultimately make health care more affordable.

“In this era of consumerism health care patients are looking for convenient care — especially the millennials who are tech savvy — they are more eager to try new ways to access health care information. That applies to behavioral health and I think that is where we are on the cutting edge.”