Telemedicine expands to psychiatrists’ sofas

AUGUSTA – Doctors have consulted on everything from colds to cancer for years through video monitors. The latest trend in telemedicine involves what are often intensely personal relationships between patient and psychiatrist.

“We are in a state where distances matter a lot in terms of what medical services are provided to people,” said Dr. Edward Pontius, medical director for the Maine Telepsychiatry Initiative. “Telemedicine erases distance.”

The “telepsychiatry” initiative that began this summer in Maine attempts to link rural patients to doctors in bigger cities using high-capacity phone lines, video cameras and television screens.

Maine has about 210 sites equipped for telemedicine, but only two locations are using telepsychiatry: the Regional Medical Center of Lubec and Jackman Regional Health Center.

Dr. Patricia Doyle, a family practitioner who works at the Jackman health center, has long been forced to refer pediatric patients needing psychiatric care to Skowhegan, where the wait for an appointment is often several months.

But now, at least one of her patients has met with a child psychiatrist without leaving Jackman.

The initiative is receiving $135,000 in startup money from the Maine Health Access Foundation, an Augusta-based charitable group that seeks to improve health care access for underserved patients.

Wendy Wolf, executive director, said the group funded the telepsychiatry initiative because the need for psychiatric care is acute and because mental health can have dramatic effects on physical health. “It’s something that really needs attention in Maine,” she said.

Pontius admits there are advantages to face-to-face meetings. Telepsychiatry does not allow doctors to take in some physical clues. A doctor might suspect a disease such as diabetes if a patient has “fruity-smelling breath,” he said.

But the video picture is clear enough to allow doctors to pick up on most physical clues, he said. Psychiatrists will notice unusual body language or nervous ticks and incorporate the symptoms into their diagnoses.

“It’s important to note that none of the organizations that are participating in this program are backing away from providing face-to-face service,” Pontius said. “But there are real limits on how often we can bring face-to-face service to rural America.”

Eight health care nonprofits – including Augusta-based Crisis & Counseling Centers, Waterville’s HealthReach Network and Saco-based Sweetser – are participating in the telepsychiatry initiative.

Officials hope soon to expand the program, but there have been problems. At this point, only MaineCare has been willing to reimburse telepsychiatry treatments. Whether the program can grow substantially and become viable depends largely on insurers paying for the service. Pontius said negotiations with insurers are continuing.

Those involved hope the program expands with additional funding.

“There are times when you need to be in person,” said Richard Karges, executive director at Crisis & Counseling Centers. “But most times, telemedicine saves so much time and expense. It’s really an advancement.”