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Informed consent for telemedicine treatment


Many states require that clinicians, in order to use telemedicine, obtain “informed consent” from prospective patients. This mandate, though intended to provide good information to the public, may have the opposite effect, as it implies, misleadingly, that seeing a clinician in person is known to be superior to treatment through telemedicine. It also misleadingly implies that the clinician knows better than the public how using telemedicine will affect their treatment. Nearly every person has their own extensive experience with video chatting, messaging, and talking on the telephone, and what they like and dislike about it. A clinician listing their conjectures about how telemedicine compares to traditional in-person treatment devalues the more relevant knowledge the prospective patient (we call them clients) already holds. Our advice: choose whichever type of treatment appeals to you most. Psychiatric treatment, in person or through telemedicine, gets most people better, and the most effective choice for you is the one you are most likely to get.

This is our informed consent, but in the true sense of the word: that you know the same relevant information that we know. It is hard to perform research comparing the efficacy of telepsychiatry to traditional in-person meetings. The research that exists hasn’t established that either approach is superior. What clinicians know comes less from our medical experience than from our experience with the Internet, which is experience that you have as well. The most obvious advantage of having a traditional in-person meeting with a clinician- that one performs a physical exam in which you hold, feel, and listen to a person’s body- doesn’t usually apply to psychiatry, as we rarely do physical exams. So don’t that you are missing important information - trust your intuition as to what format you will prefer.

Things to consider in considering healthPiper.


HealthPiper’s service is very different than traditional psychiatry. There are many benefits to healthPiper’s approach, including being more convenient, transparent, and efficient. But like any significant decision in life, choosing one path over another, even if thoughtfully done, still can end badly. One could buy a heavier car because it is safer in a collision, but that same weight could cause it to lose grip on a turn and to spin out. A good decision helps your odds of getting what you want, but sometimes, as life unfolds in its unpredictable way, the less good decision would have turned out better. Close to 100 Americans die of suicide every day, and without a doubt, if we continue to grow, healthPiper clients will die of suicide. And it is quite possible that for some of them, if they had instead gotten conventional treatment, or even gotten no treatment at all, they wouldn’t have died of suicide. We are confident that healthPiper will prevent many suicides (and already have a client who wrote in a review that our service saved her life), but as with the heavy car, a benefit in one situation can be a problem in another. More broadly than suicide, we are confident that healthPiper has transformed many lives, and will continue to do so. But just as with suicide, things may unfold such that for a particular person, they would have done better in conventional treatment.

While it is possible to send a message to healthPiper at any time, we are not configured to be a solution for an emergency- if you are ever think you might be at risk of imminent harm or death, call 988 or go to the ER. We don’t read messages sent at night until the next day, and even during the day, while we almost always respond before we go to bed that night, we may not read your message for hours. And even if we do read your message, if you are in imminent danger, you can be sure that we will tell you is to call 988 or go to the ER. It is a medical emergency – don’t hesitate. That is what the emergency systems are for – to keep you safe.

If you do choose healthPiper, you can be sure that we are sincere in what we do, that we believe we make life better for many people, and that there are clear ways that we are an improvement over conventional treatment. But in reshaping the way treatment is delivered, even though we have good reasons to, many valuable elements are lost. Traditional psychiatry has important qualities. There can be a more immediate connection being together in a room with another person. The less structured approach of traditional psychiatry, while it can allow errors, also may be more flexible in managing complex situations. After you read our informed consent, also read our Question and Answers section, and ask any questions you may have as you try to determine if healthPiper is a good choice for you. We, like you, only want you to use healthPiper if it is a great solution for you, and we will refer you elsewhere (we refer many people elsewhere) if we perceive that a different approach is more likely to work for you.

healthPiper is messaging and self-report focused


Traditional psychiatric treatment is built around appointments. Whenever a patient wants to have a substantive communication with their clinician, they are steered to schedule an appointment. There are a few reasons for that, including that payments are based on appointments, and perhaps as a consequence, medical record systems are not designed for clinicians to review and use between appointments. Many clinicians also hold the belief that it’s necessary to have mandatory periodic appointments to “evaluate” the patient. At healthPiper, we believe, based on our experience and also on research, that people often are more comfortable being honest and accurate through messaging and they are in an appointments. We also believe that the ease of spontaneous, accurate communication through messaging makes it a much better foundation for collaborative treatment than infrequent periodic appointments. We do schedule a minimum of one hour for an initial evaluation, but after that treatment is built upon messaging and are Symptom Scan™, which provides a quantitative measure of your symptoms over time. We do have additional appointments as a possible tool, but we encourage trying to first communicate through messaging, and we find that for most they find it to be a better solution.

There is less experience with telepsychiatry


Psychiatric care has traditionally been provided through a series of in person meetings, and most clinicians have more experience giving treatment in this format. During their training and afterwards, clinicians work with many patients with a variety of issues, and over time the clinicians refine approaches to prevent obvious mistakes. Of course, the benefit of experience must be balanced against the power of information technology to organize and track data. For example, at healthPiper our software alerts us as to when you should be running out of a medication and we will check in with you and refill it proactively. With the typical clincian, they count on you contacting them or your pharmacy when you are running low. If you neglect to do that you may end up having your medication stop abruptly.

Information technology often doesn't work as it is supposed to


To live in the modern world is to know the regularity with which apps, websites, and cloud computing go wrong. Even the biggest organizations with the most robust expertise in security get hacked and have data stolen. The United States National Security Agency, which possesses perhaps the greatest expertise in the world as to the vulnerabilities of information technology, was itself hacked. Some of the best funded and most prestigious healthcare organizations such as anthem Blue Cross and UCLA Medical Center have also been hacked and had data stolen. The British National Health Service was subject to a ransomware attack, which locked up the records of millions. Other errors that we are all familiar with from our interactions with information technology occur with regularity in healthcare as well. Sound can be distorted in video chats and words might be misheard, when that happens, when it isn’t caught that can lead to potentially serious mistakes. (Of course, usually one can tell if the sound is unclear, and asked for the words to be repeated). Notes or messages could be lost or put into the wrong person's records. People's Internet connections fail with some regularity which most obviously blocks communication, but more daunting, can cause people to not realize they have missed a message. All of these sorts of errors have been reported in the press, some with regularity.

Like every other health technology-based provider, healthPiper is vulnerable to these sorts of things going wrong. We are a small company which means that we don't have as extensive resources for security as does a large company. (At the same time though, we may be a less visible target). We also try to do the right thing. We spend a lot of time thinking about security, and always make it our priority. Many people try to make money selling healthcare information, and that is off the table for us. Under federal healthcare laws, it can be legal to share information that is "de-identified"-altered so that supposedly others cannot figure out the person's identity. We recently turned down the services of an otherwise very good technology company because they wanted to be able to sell "de-identified data" from our clients. We refused, and the deal was off. Of course, there are risks to the security of medical records whether you were getting services through telemedicine or not. Virtually all prescriptions are held in electronic form, and most medical records are now held in electronic database that is stored in the cloud. The risks of traditional paper records, while different than those of electronic records, are nonetheless significant. Electronic records generally keep an automatic record of who reviews them, while paper records do not. Still, stealing paper records require direct physical access, while electronic records can be attacked from anywhere it the world.

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