Family and Caregiver Schizophrenia Discussion Forum

APA Practice Guidance for Covid-19

You may want to be informed about this guidance issued by the Department of Health and Human Services, FDA and at state levels related to COVID-19 to assist psychiatrists with providing mental health and substance use services. https://www.psychiatry.org/psychiatrists/covid-19-coronavirus/practice-guidance-for-covid-19

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What caught my eye was the directions in regard to the regular lab work required for Clozapine.

Yes. My FM should still be able to safely get the next month blood test for Clozapine, but some people may not be able to do that at their normal location or may not feel safe in doing so.

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Thank you @hope! I did get my son out yesterday, but knew that if he balked, I would need to pursue getting that requirement waived!

I also checked with his PDOC’s office and see they have telemedicine check-in set up now.

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It will be interesting to see how Telehealth develops through this with regard to Hippa.
Please keep us posted.

I had a ‘telehealth’ visit with my psychiatrist last week. It consisted of a FaceTime call. Nothing particularly special about it. I’ve done phone sessions in the past with psychiatrists and psychologists. The most difficult part of it was payment.

There have been HIPPA compliant ways to conduct treatment remotely for years. And telephone sessions, because they do not transmit information over the internet, have not been seen as presenting any special privacy issues with respect to HIPPA per se.

Technically, HIPPA, which was developed by Congress, applies to the electronic transmission of protected health information. However, in common use, HIPPA is often used (by doctors and patients alike) to mean “confidentiality of health information “. And the HIPPA regulations do have very strong teeth as well as applying to almost any doctor these days as it is nearly impossible to avoid using some means of electronic transmissions in clinical practice (whether via electronic record keeping, which is mandated in some fields, or electronic billing, which is nearly impossible to avoid).

So the lack of remote treatment via telemedicine has nothing to do with HIPPA per se, but rather is due to other factors, some associated with practical issues (such as not being able to conduct a physical exam remotely), others with ethical issues (privacy can be harder to ensure and some people have issues that are not suited for remote treatment) and others hinging on insurance reimbursement (many plans do not reimburse for telemedicine, or will do so only under very restrictive condition).

Many insurance plans have agreed to reimburse for a broad range of remote services for the duration of the pandemic so that people will be able to obtain treatment with as little in-person contact as possible.

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Agreed @Itsastruggle, although technically portions of many phone and video calls travel over the Internet nowadays, they are generally considered to be reasonably secure from eavesdropping. As I recall HIPPA and portions of the ACA laws are about maintaining privacy and custody of medical records, and since most doctors sessions are not recorded-- there’s not a high bar of security. Session notes and so on do need additional protection measures, however.

Because technology moves much more quickly than legislature, archaic technologies often form the backbone of highly regulated industries. That’s why FAX is still heavily used in medical communication, even though it’s slow and the underlying system in unencrypted and can sometimes travel over non-private networks.

Per blood testing for Clozapine, I got a routine non-pysch blood test a few days after things started to “get real”. I purposely scheduled an early appointment to get a less contaminated office. It was a stark contrast to previous blood testing at the same office. I was greeted at the door with people in full protective gear and they wouldn’t let me in until they reviewed my order. The waiting area was arranged to maximize social distancing. Check In was automated and mostly touchless. The waiting room was empty and I only saw one person in it as I left. The blood draw itself was fairly normal, although they didn’t want the usual ID or insurance cards or anything, nor did they require arranging payment at the time. Aside from passing the entry gauntlet, it was easier and arguably less scary than other visits.

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Yes, fax and phone were basically grandfathered in - in many ways, traditional faxes are a more significant privacy risk than newer methods, as they have to be placed where unauthorized people cannot access the output etc. But because they were in place prior to HIPPA, they get to stay . . . .

I have had to get some treatment for some emergent health issues myself since all this started. There was a big difference in precautions at the urgent care last week via the week prior, where the staff seemed a bit unconcerned. Have to say, I felt safer the second time around, with everyone being a lot more careful. Glad you also had a relatively positive experience.