Providers and programs should take steps to minimize in-person interactions throughout the COVID-19 crisis. Telehealth is an important tool for maintaining access to treatment while minimizing the risk of transmission of the coronavirus. See also ASAM’s Access to Telehealth Guidance, which provides an overview of recent federal and state policy changes to enable telehealth during the COVID-19 crisis.
Telemedicine or virtual visits should be used whenever possible and appropriate to provide addiction treatment to patients. It is very important to maintain close contact with patients during this time of stress, anxiety, and social isolation. Telehealth, including both telephone based and audio-visual based check-ins and visits, are an important way of staying connected with and managing patients. Federal regulations have been relaxed during the COVID-19 pandemic to facilitate the use of telehealth, including allowing providers to use non-HIPAA compliant technologies which at the time of this writing include Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, and Skype. These changes should make it easier to rapidly transition to telehealth.
Telemedicine communication conducted using an audio-visual, real-time, two-way interactive communication system is preferred but some audio-only visits may also be considered. For example, some patients may not have the technical capabilities available for video visits.
Providers should carefully assess whether an in-person visit would change the management of a given patient. For stable patients, the risk of in-person visits is likely to outweigh the benefits. Patients who are unstable, or patients that do not have reliable access to a telephone (e.g. homeless patients) may still benefit from in-person visits. Providers and programs should consider infection mitigation strategies for in person visits. See Infection Mitigation: Outpatient guidance.
Communication with patients is key during any transition to telehealth services. Programs should work with patients to make sure they understand how to join a telehealth visit and should be prepared to adapt to any technical issues that arise. See guidance from the National Council on Best Practices for Telehealth During COVID-19 Public Health Emergency: https://www.thenationalcouncil.org/wp-content/uploads/2020/03/Telehealth_Best_Practices.pdf?daf=375ateTbd56 and the APA’s Telepsychiatry Toolkit: https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit
During a telemedicine encounter, face masks should be discouraged unless there is a specific need. This can facilitate a more satisfactory connection between the patient and provider, even though they are not in the same location and are connected via video rather than in person.
In addition to the typical assessments and treatment modalities, during this crisis telehealth counseling sessions should address how the patient is responding to the COVID-19 crisis, and should focus on reinforcing social distancing and hygiene practices. Counselors should help patients to problem solve around these issues. Counselors should also talk to patients about what they should do if they develop symptoms.
Patients should also be encouraged to participate in virtual support groups if appropriate for the individual. See ASAM’s COVID-19 guidance for Support Group Access.
Providing services through telehealth does require clinicians to adapt their practices. Programs should encourage staff to participate in virtual trainings on how to effectively provide services through telehealth.
Resources
Considerations for Telehealth Documentation
Verbal or written consent should be obtained from the patient before each telehealth visit. If the clinician is not using a HIPAA compliant telehealth platform, the patient should be informed about this and about the potential security limitation, and their verbal or written consent to continue should be obtained.
All documentation should note the patient’s consent for treatment via telehealth (acknowledging the potential HIPAA violation if appropriate). It should also document the date and time of the call, the location of the patient and the provider at the time of the visit, and the technology used for the connection. It is important to verify the patient’s identity, especially for phone contacts. Each note should describe how the patient’s identity was verified. As with all services the note should document the discussion during the call, including information regarding assessment of the patient’s mental status, mood, quality of speech, etc.; outline the plan for the next contact; and contain any other information consistent with coding requirements. The note should also indicate that the encounter is in the context of the COVID-19 crisis, and describe how this was addressed during the visit (e.g. reinforcing the importance of physical distancing, assessing how the patient is coping with the stress, anxiety and social isolation during this crisis, etc.).