Telehealth: clinical guidelines and technological standards for telepsychiatry
Pineau G, Moqadem K, St-Hilaire C, Perreault R, Levac E, Hamel B, Obadia A, Caron L
Record ID 32006000167
This report aims at achieving two objectives: proposing clinical guidelines and technological standards that would foster the optimal use of telepsychiatry. Although it doesn't deal with them in great detail, this report also discusses the economic, legal, and ethical aspects involved as well as human and organizational factors to highlight their importance in implementing successful programs.
The definition of clinical guidelines and technological standards aimed at standardizing telepsychiatric practice will promote its largescale implementation. This would enable Quebec to take its place within the framework of large-scale projects funded by Health Infoway. When seen from the standpoint of the restructuring of primary care and the reorganization of highly specialized medicine overseen by Quebec's four university teaching hospital networks (RUIS: French acronym for "reseaux universitaires integres de sante"), this technology could prove to be a valuable asset in ensuring more equitable distribution of psychiatric expertise throughout the province. This would promote the smoother development of telepsychiatry in Quebec.
Based on the considerations presented above, AETMIS recommends that the Ministere de la Sante et des Services sociaux (MSSS) adopt the main guidelines and technological standards proposed in this report in cooperation with the appropriate authorities. AETMIS is firmly convinced that telepsychiatry can help improve the offering of quality health care and proposes procedures that could support medical activities along these lines.
This would promote the harmonious development of telepsychiatry in Quebec. Specifically, provisions must be made for a central reservation system and a generic consultation tool as well as fee-for-service remuneration for physicians. Failure to provide for all of these conditions would be a significant disincentive to physician involvement in telepsychiatry. In addition, a certain number of key actors must be involved to support implementation and use of telepsychiatric services. All actors must have appropriate training.
In order to provide a medium that yields a quality practice environment, the technological infrastructure must be upgraded to a minimum of 384 Kbps of bandwidth using an H.263 datacompression protocol and then be gradually upgraded to an optimal of 384 Kbps of bandwidth using an H.264 data-compression protocol. Data-packet loss should not exceed 0.5%. The minimum latency time should be less than 500 ms and the optimal latency time less than 300 ms. These standards must be applied to the entire data capture, transmission, and reception chain. Telepsychiatric consultation rooms containing the required equipment and accessories should be set up in appropriate clinical settings where needs are greatest.
Taking into account human and organizational aspects plays a part in ensuring the success of this type of activity. The legal and ethical aspects must also be considered. Moreover, a detailed economic analysis should be carried out prior to any massive investment in telepsychiatry. Finally, implementation of psychiatry should be subjected to rigorous downstream assessment in order to improve management and performance.
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Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)