Brian J Grady, M.D.Brian J Grady, M.D.Director TeleMental HealthDirector TeleMental HealthDepartment of PsychiatryDepartment of PsychiatrySchool of MedicineSchool of MedicineUniversity of MarylandUniversity of Maryland

TeleMental HealthTeleMental Health

Today’s Topics Today’s Topics

• TMH OverviewTMH Overview• University ProjectsUniversity Projects• TMH PolicyTMH Policy• Future DirectionsFuture Directions

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TeleMental HealthTeleMental HealthOverviewOverview

• Beginnings Late 1950’sBeginnings Late 1950’s• Interactive “Television” 1960’s to Interactive “Television” 1960’s to

1990’s1990’s• ““Affordable” VideoConferencing Affordable” VideoConferencing

late 1990’s to mid 2000’slate 1990’s to mid 2000’s• Evidence Based TMH mid 2000’s Evidence Based TMH mid 2000’s

to presentto present

The MergerThe Merger

Technology

The MergerThe Merger

Technology

Clinical Needs

The MergerThe Merger

Technology

Clinical Needs

Telemental Health

The MergerThe Merger

Technology

Clinical Needs

Access

UMB TMH ProjectsUMB TMH Projects

• Maryland Youth Practice Improvement Committee – Maryland Youth Practice Improvement Committee – Consortium of Psychiatry Department UMB, Psychiatry Consortium of Psychiatry Department UMB, Psychiatry Department JHU, Mental Hygiene Administration, Department JHU, Mental Hygiene Administration, Regional Institutes for Children and Adolescents, State Regional Institutes for Children and Adolescents, State C&A Inpatient UnitsC&A Inpatient Units

• School Based Mental Health ProjectsSchool Based Mental Health Projects– Baltimore, Western High School (’04/’05)Baltimore, Western High School (’04/’05)– Prince George Co, Suitland HS & Kettering MSPrince George Co, Suitland HS & Kettering MS

• Health Resources and Services Administration Grant - Health Resources and Services Administration Grant - Consortium of Mid-Shore MH CSA, Mental Hygiene Consortium of Mid-Shore MH CSA, Mental Hygiene Administration, Garrett Co Core Service Agency, St. Administration, Garrett Co Core Service Agency, St. Mary’s Co Core Service Agency, Psychiatry Department Mary’s Co Core Service Agency, Psychiatry Department UMBUMB

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Required ResourcesRequired Resources

• Clinical Champion Distant SiteClinical Champion Distant Site• Site Champion Originating SiteSite Champion Originating Site• Administrative SupportAdministrative Support• Technical SupportTechnical Support• Financial SupportFinancial Support

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FinancingFinancing

• GrantsGrants– Health Services Resources AdministrationHealth Services Resources Administration– Department of AgricultureDepartment of Agriculture– Maryland Community Health Resources Maryland Community Health Resources

Commission Commission • Fee for ServicesFee for Services

– MedicareMedicare– Maryland Public Mental Health SystemMaryland Public Mental Health System– Third Party ReimbursementsThird Party Reimbursements

• Contractual AgreementsContractual Agreements14

TMH PolicyTMH Policy

– RegulationsRegulations• Board of PhysiciansBoard of Physicians• MedicareMedicare

– Balanced Budget Act (BBA) of 1997Balanced Budget Act (BBA) of 1997– Benefits Improvement and Protection Act of Benefits Improvement and Protection Act of

2000 (BIPA)2000 (BIPA)

• MedicaidMedicaid– Draft RegulationsDraft Regulations

Medicare Originating SitesMedicare Originating Sites(additional Medicaid proposed) (additional Medicaid proposed)

• Physicians or practitioner officePhysicians or practitioner office• HospitalHospital• Critical Access HospitalCritical Access Hospital• Rural health clinicRural health clinic• Federally qualified health centerFederally qualified health center• (Elementary, middle, high, or technical school with a (Elementary, middle, high, or technical school with a

supported nursing, counseling or medical office. A supported nursing, counseling or medical office. A college or university student health or counseling college or university student health or counseling office)office)

• (County Health, Human and/or Social Service offices (County Health, Human and/or Social Service offices or clinics and other county offices appropriate for or clinics and other county offices appropriate for private clinical evaluations and services)private clinical evaluations and services)

Qualified Geographical AreasQualified Geographical Areas

MedicareMedicare

• Health Practice Shortage Health Practice Shortage Areas (HPSAs)Areas (HPSAs)

• Non-Metropolitan Non-Metropolitan Statistical Area (MSA) Statistical Area (MSA) countiescounties

• Entities that are Federal Entities that are Federal telemedicine telemedicine demonstration projectsdemonstration projects

Technical RequirementsTechnical Requirements

1. Minimum ISDN or IP bandwidth using H.264 1. Minimum ISDN or IP bandwidth using H.264 video protocol video protocol >> 256 kbps 256 kbps

2. Monitor: minimum, non-anamorphic, 2. Monitor: minimum, non-anamorphic, net display size of 16" diagonallynet display size of 16" diagonally

3. Minimum resolution of 1 Common 3. Minimum resolution of 1 Common Intermediate Format/Source Input FormatIntermediate Format/Source Input Format

4. Switched Network or Encryption4. Switched Network or Encryption

Future DirectionsFuture Directions

• Vision: TeleMental Health Center of Vision: TeleMental Health Center of ExcellenceExcellence– Clinical ChampionClinical Champion– Coordinator ResourceCoordinator Resource– Technical ResourceTechnical Resource– Education, training & researchEducation, training & research

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Comments, QuestionsComments, Questions