Transcultural psychiatry made simple--asynchronous telepsychiatry as an approach to providing culturally relevant care.

OBJECTIVE: To examine the feasibility and diagnostic reliability of asynchronous telepsychiatry (ATP) consultations in Spanish and ATP consultation with Spanish-to-English translation. SUBJECTS AND METHODS: Twenty-four interviews of Spanish-speaking patients were videorecorded by a bilingual clinician who also collected patient history data and gave the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to each patient. The ATP data (video of the interview and patient history) were forwarded for psychiatric consultation and a diagnostic assessment by the investigators. The ATP data were then examined separately by two Spanish-speaking psychiatrists, before being translated into English and then re-examined by two English-speaking psychiatrists. Agreement between the expert diagnoses of the investigators and the diagnoses from the Spanish consultations, the Spanish-to-English translated consultations, and the SCID-I results was assessed using kappa statistics. RESULTS: We found acceptable levels of agreement for major diagnostic groupings among the Spanish- and English-speaking psychiatrists. Kappa values for diagnostic agreement between the expert and the translated consultations, the original language consultations, and the SCID-I were at least 0.52 (percentage agreement, 79%) and higher. CONCLUSIONS: ATP consultations in Spanish, and those translated from Spanish to English, are feasible, and broad diagnostic reliability was achieved. The ATP process allows for rapid language translation. This approach could be useful across national boundaries and in numerous ethnic groups. Cross-language ATP may also offer significant benefits over the use of real-time interpreting services and has the potential to improve the quality of care by allowing for the addition of culturally relevant information.

PsychVACS: a system for asynchronous telepsychiatry.

OBJECTIVE: To describe the technical development of an asynchronous telepsychiatry application, the Psychiatric Video Archiving and Communication System. METHODS: A client-server application was developed in Visual Basic.Net with Microsoft(®) SQL database as the backend. It includes the capability of storing video-recorded psychiatric interviews and manages the workflow of the system with automated messaging. RESULTS: Psychiatric Video Archiving and Communication System has been used to conduct the first ever series of asynchronous telepsychiatry consultations worldwide. A review of the software application and the process as part of this project has led to a number of improvements that are being implemented in the next version, which is being written in Java. CONCLUSIONS: This is the first description of the use of video recorded data in an asynchronous telemedicine application. Primary care providers and consulting psychiatrists have found it easy to work with and a valuable resource to increase the availability of psychiatric consultation in remote rural locations.

Disruptive innovation: the future of healthcare?

The traditional face-to-face doctor-patient relationship is the core of conventional medical practice. One key aspect of this changing relationship is the increasing dependency on asynchronous data collection in clinical consultations. Such electronic communications and data streams may be numeric, text-based, audio, digitized still pictures, video and radiologic, as well as emanating from multiple medical devices. While asynchronous medicine may be established in specialties like radiology and dermatology, there is little research regarding the use of asynchronous medicine in areas of medicine that traditionally rely on the physical doctor-patient interaction such as primary care, internal medicine, geriatrics, and psychiatry. The practice of psychiatry stands out as a discipline that is highly dependent on the quality of the physical meeting between the doctor and the patient, yet even in this specialty it is possible to utilize asynchronous medicine for some types of psychiatric consultations. Asynchronous medicine has the potential to be significantly disruptive to our current healthcare processes, as well as more clinically and economically efficient.

Telemedicine can make healthcare greener.

The American healthcare industry is generally lacking environmentally sustainable practices. The environmental impact of healthcare practices in the country has been largely disregarded due to ambivalence, ignorance, and fears of additional costs and regulations. The current practices continue to pollute the environment by requiring large amounts of travel and paperwork by both the patient and the clinician. Telemedicine and health information technology help save time, energy, raw materials (such as paper and plastic), and fuel, thereby lowering the carbon footprint of the health industry. By implementing green practices, for instance, by engaging in carbon credit programs, the health industry could benefit financially as well as reduce its negative impact on the health of our planet. Companies that reduce their carbon emissions by implementing energy-saving practices can sell their carbon credits to companies that emit more carbon than permissible by their legally binding commitment. These carbon profits can then be used for healthcare research or to provide healthcare to the underserved. Alternatively, the savings could be used for green purchasing and to implement other carbon-reducing activities. This report reviews the numerous possible options for the American health industry to become greener and lower its carbon footprint while at the same time becoming more time- and cost efficient.

Psychiatric co-morbidity in women presenting across the continuum of disordered eating.

OBJECTIVE: To compare the prevalence and correlates of psychiatric co-morbidity across a large sample of college women without an eating disorder, those at high risk for an eating disorder and women diagnosed using DSM-5 criteria for an eating disorder. PARTICIPANTS: 549 college women aged 18-25. METHODS: Data from the Eating Disorder Examination, the Structured Clinical Interview for DSM-IV Axis I disorders and self-report questionnaires were analyzed using logistic regression for categorical data and ANCOVA for continuous measures. RESULTS: Eating disordered symptomatology was strongly associated with anxiety disorders, mood disorders and insomnia. These co-morbidities (type and severity) tend to increase with eating disorder symptom severity. CONCLUSIONS: Prevention and treatment programs for eating disorders need to address the high levels of mood, anxiety and sleep problems in this population. The findings on insomnia are novel and suggest that sleep disturbance may play an integral role in eating-related difficulties.

The psychiatrist-patient relationship of the future: anytime, anywhere?

The core doctor-patient relationship is changing and becoming more fluid. Many factors are causing the changes, but they are being underpinned by the current technological revolution, which has spawned terms such as e-patients, health 2.0, participatory medicine, and virtual medicine in cyberspace. The Internet is being used so creatively and commonly by both patients and doctors that it has become literally a "part" of the doctor-patient relationship. To explore how the psychiatrist-patient relationship is changing, five simple questions are examined: How are patient expectations and behaviors changing? Who is using the Internet for mental health care? What online mental health services are currently being offered? How are current and past models of the psychiatrist-patient relationship being affected by these changes? And what is the psychiatrist-patient relationship of the future likely to be? Psychiatrists working in this environment will need to make changes to their practices over time. It is likely that their relationships with patients will continuously change, gradually becoming more participatory and ubiquitous, as care is provided both face-to-face and online-and literally anytime, anywhere.