In October, the Army introduced a pilot program to the battlefield allowing Service members in remote locations to connect with mental health specialists. Psychiatrist Lt. Col. Rafael Semidei, Sr., stepped up to be the first to use the Tele-behavioral Health System for remote consultations.
The reservist first used a video teleconference (VTC) system six years earlier to remotely connect with patients located throughout southwestern Virginia. Drawing upon his past experience, Lt. Col. Semidei now uses the new system in Iraq to see more patients, while reducing the amount of dangerous and time-consuming travel to and from remote locations.
While working in various clinical settings, Lt. Col. Semidei used different computer systems to digitally capture electronic medical records (EMRs), including the system fielded and supported by MC4. The use of templates in theater condenses the amount of time required to chart patient data, allowing him to spend more time with patients.
Why were you the first to use the Tele-Behavioral Health System?
It was not my intention to be first. When I learned about the pilot program in theater, I intended to stay in the background. I wanted to ask questions to learn how the system would work. Like other deployed providers, I have a very full schedule. I didn't want a new system to negatively impact the care administered to my patients. When I learned more about the system, I understood the benefits.
- “The Tele-behavioral Health System extends the reach of physicians. I now see more patients and spend less time traveling to and from locations.”
Not many providers have jumped at the chance to test the new system. Providers are typically hesitant to implement new systems or processes. We like proven solutions. My experience with other consultation systems might have reduced my inhibitions to take on the challenge to test the new system in Iraq.
What are the benefits of the new system?
The Tele-behavioral Health System extends the reach of physicians. I now see more patients and spend less time traveling to and from locations. The distance between patients and mental health specialists hinders the ability to offer the highest level of care to stabilize those in need.
Previously, I would travel 15 miles via helicopter for a one-hour consultation. The downside was securing the round-trip travel. The process could consume an eight-hour day.
For an appointment in my office, some of my patients leave their location at 4 a.m. and return at 10 p.m. Others from remote locations require days to travel to and from appointments. Travel time depends upon convoys and the ability to secure air transportation. This is a significant loss of man-hours.
With the Tele-behavioral Health System, I consult with patients on a more regular basis. Patients do not have to undergo the additional stress of travel. I provide the same level of care consulting with patients remotely as I do with those who sit in my office. The system works very well.
Sgt. Marie Swieta, noncommissioned officer in charge with the 547th Area Support Medical Company (Combat Stress Control), is an instrumental part of my efforts. She handles everything that occurs before and after the appointments. I couldn't effectively do my job without her assistance.
How does the Tele-behavioral Health System in theater compare to other systems you have used?
I first learned about remote consultations nearly 10 years ago. Since that time, I worked for a clinic system that offered mental health services in southwestern Virginia. We supported a many as 18 clinics dispersed throughout the region.
Mental health specialists are in short supply everywhere, but especially in southwestern Virginia. I spent much of my time driving to and from appointments. I would drive as many as six hours for a consultation and my patients would also have to drive long distances.
In time, we connected the clinics with a VTC system. Once in service, the patients didn't mind conducting appointments via the remote system. They received the required treatments and I gathered the information I needed to manage their care in a more reasonable timeframe.
Did you experience a steep learning curve to use tele-behavioral health systems?
The learning curve is small. I think most of the psychiatrists and psychologists already have the necessary skills to use such a system. Providers need to exude a little more effort to develop a relationship and bond with a patient. They also should exaggerate body motions on camera to affirm a patient's comments, such as nodding more or repeating statements.
Another aspect to get accustomed to is the transmission delay of the audio and video signals. Sometimes you hear a patient talking, but the patient's mouth isn't moving on the screen. The dialogue isn't as natural as it would be with in-person consults. You have to wait a little longer to make sure patients finish their thoughts.
The issues are minor and manageable. In time, you become accustomed to the quirks and the process becomes natural.
How have other providers reacted to the new system?
Since I began using the Tele-behavioral Health System in theater, I've talked with providers of various disciplines. Most would rather see a patient face-to-face. Remote consultations may not be appropriate for every medical discipline, but it is a tool to offer services to Service members at remote locations where providers do not have a permanent presence. As providers have greater exposure to the system, then they'll become more comfortable with it and the system will receive greater use.
What are your thoughts of the different systems you have used to capture EMRs?
I've digitally captured medical records for many years in various clinical settings. All of the systems are comparable. They use check boxes to annotate the care and they include a narrative section for additional information.
The main difference between MC4 and civilian systems is that MC4 is geared more toward general medicine and not behavioral health. Civilian systems include specific modules to chart behavioral health care. Except for wanting a more robust behavioral health section, MC4 works very well.
At one time, I worked with the Department of Veterans Affairs (VA). Many providers view the VA's EMR system as the best EMR system. I think that MC4 is definitely a step ahead of the VA's system.
With minimal training, providers can be functional to perform their job. With more training, providers can take full advantage of the powerful system. Plus, the use of templates is a tremendous benefit to generate neat and complete notes.
How have templates aided your documentation efforts while deployed?
The use of templates helped me to decrease the time spent documenting patient data. I can now generate a note within 20 minutes. Typing the same note would take me much longer. Templates decrease the amount of words needed to convey the same information entered through free-hand text. Templates are good to chart the target symptoms of the psychopathology, past medical histories and medications.
MC4's Leann Micheals was invaluable to the development of my templates. I created a couple, but I needed them to do capture more information. Within a couple hours, she created a few templates. If I created the same templates, the process would have taken me days.