In today’s world, everything is connected and online. The internet is the backbone that keeps our news, entertainment, health data, and everything in between synched and linked together. As demand continues to rise for quick, efficient solutions for our daily tasks — both big and small — it was only a matter of time until online healthcare wasn’t just requested, but demanded as standard of care.
Enter telehealth, a general term that describes the use of digital technologies to foster long-distance clinical healthcare services and education. During the height of the COVID-19 pandemic, the need for telehealth services increased dramatically, pushing providers and patients to resort to virtual online care for their appointments. Yet, in the following years, many mental health professionals and their clients are still sticking with telehealth-only appointments, with ~20% of psychologists exclusively using remote services.
Key takeaways
- Mental health professionals are increasingly opting for telehealth-only private practices to improve accessibility for those who don’t have access to in-person behavioral healthcare.
- Telehealth-only practices also reduce or eliminate commutes, leading to greater ease and convenience.
- Lessening the need for a dedicated brick-and-mortar office can lead to significantly reduced costs on things like rent and utility bills.
What is a telehealth-only practice?
A telehealth-only practice relies exclusively on internet-connected technologies, so you have the flexibility to offer care virtually. Telehealth-only practices don’t need to rely exclusively on physical office locations and won’t accept clients who are exclusively seeking in-person treatment.
Naturally, there are many benefits for both mental health professionals and patients using telehealth for behavioral healthcare: Lack of a work commute, reduced transportation barriers and travel-related costs, increased scheduling flexibility, and greater opportunity for comfort during appointments.
Yet, with any business built exclusively using internet technologies, there are also bound to be challenges: Technical glitches and failures, keeping up with uncertainty using the platform(s), barriers to use for non-native speakers or clients and staff with disabilities and impairments, ensuring secure messaging and other communications, and privacy concerns.
The industry is also constantly evolving and it can be challenging to keep up with emerging and alternative technologies that seek to address common technical issues and glitches.
When weighing the pros and cons of a telehealth-only practice, the most important consideration is guaranteeing your business meets legal, regulatory, and ethical compliance. Because your practice will be conducted completely online, you’ll need optimal cybersecurity to protect your patients’ health information and safeguard your business’ compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations.
How do I set up a telehealth therapy practice?
When you’re setting up a telehealth therapy practice, there are several questions you should consider to ensure success:
- How do I prepare and train my staff for telehealth therapy?.
- What are the legal and licensing requirements for telehealth therapy?
- How do I assess the ethical and clinical risks of telehealth therapy?
- How do I ensure that your telehealth technology is reliable and accessible?
- How do I design my office setup and workflow processes around telehealth?
- Can special client populations benefit from telehealth-only practice?
- What are some key future trends and opportunities I can explore in telehealth?
We’ll explore each of these questions below.
How do I prepare and train my staff for telehealth therapy?
Depending on the size of your staff, the first step is to establish clear roles within the team. When everyone knows their specific responsibilities, you can start to set your practice up for success.
As you home in on the kinds of clients you’re looking to serve, that decision can guide you toward which telehealth technology and platforms your practice will need. Make sure to schedule regular trainings with your staff, so you and your team are well-equipped to support your clients. This includes training in technology, cultural sensitivity, and accounting for accessibility requirements.
One challenge to keep in mind with telehealth therapy is the ability to perform physical assessments. For example, the Abnormal Involuntary Movement Scale (AIMS) test is sometimes used to assess patients who are taking antipsychotics. In a telehealth-only setting, it’s important for mental health clinicians to develop ways to assess patients who are not as easy to see on screen.
After the initial onboarding process, be sure to implement ongoing check-ins and meetings to facilitate feedback, improvements, and ensure that all staff are comfortable.
What are the legal and licensing requirements for telehealth therapy?
Perhaps the most significant step in opening a telehealth practice is researching and fulfilling your compliance requirements.
First, do a thorough review of your insurance policy, including your malpractice insurance, to determine what telehealth services are covered. Before seeing clients, you will need to research reimbursement rates, comparing it with in-person rates, and determine whether your services will be reimbursed — and how — through telehealth.
There are many guidelines in place to ensure the legal use of telehealth services for behavioral care, but they tend to vary across states and countries. Depending on your plan to offer care across state and/or national borders, you’ll also need to get familiar with federal and state laws, including requirements related to licensure and prescribing controlled substances.
How do I assess the ethical and clinical risks of telehealth therapy?
As you gain new clients and continue working with existing ones, it’s essential to clearly communicate the functionality of the telehealth technology and programs you’ll be using. You should set clear expectations, explain the fully remote nature of your appointments, and provide examples of what devices can be used for appointments, including computers, tablets, and smartphones.
During these conversations with your clients, you should highlight different telehealth services and analogs they may already use (e.g., an audio-only call, instant messaging through a healthcare website, etc.) to gauge their comfort level and ensure the appropriateness of this kind of virtual care.
Additionally, you should reinforce the extensive privacy and security protections that you’re instating, which will help prevent breaches of personal information, medical history, financial and/or identity theft, bias, or discrimination—all which are required by HIPAA rules.
It’s important to reassure your clients about the security of telehealth services; however, you must also warn them of potential technology glitches and issues, including:
- Viruses and malware
- Unauthorized access by hackers and cyber criminals
- Accidental disclosures
To ease some of these fears, give your clients information about the privacy and security measures of the vendor(s), including the names of the technologies you’re using, and where to view their privacy and security policies online. Your clients should also be able to file a privacy complaint, if needed. Learn more here.
For any issues that do arise, make sure you implement an emergency plan.
How do I ensure that your telehealth technology is reliable and accessible?
When choosing your practice’s telehealth technology, you must select a secure video conferencing platform that meets the standard hardware and connectivity requirements. The National Institute of Standards and Technology has created a special publication to help providers like you steward a secure remote patient monitoring ecosystem and feel confident in the vendors you’re choosing.
Because electronic health records are often a prime target for hackers and systemic malware, you’ll need to ensure your operating systems meet standard cybersecurity requirements to protect your clients’ health information. This will also help you safeguard your business’ HIPAA compliance. Guidance provided by the U.S. Department of Health and Human Services Office for Civil Rights (OCR) outlines how telehealth technologies can comply with HIPAA.
While different state legislations vary, there are some common themes:
- Ensure that you’re transparent about how patient data is collected and stored
- Restrict the use of patient health information in the commercial marketplace
The OCR and the Federal Trade Commission (FTC) are also helpful resources in providing guidelines to protect patient privacy and guarantee the secure handling of sensitive health data.
How do I design my office setup and workflow processes around telehealth?
Although your telehealth-only practice won’t rely exclusively on a physical office space, it’s still important to consider how to optimize the look and feel of your clinical space. First, consider the furniture, equipment, and decor you’ll need: How are you designing the space for easy access to electrical outlets and internet cables? Does your space have proper ventilation, heat, and airflow?
Then, you must consider patient accessibility, which includes:
- Addressing ergonomic concerns for the computer and/or smartphone camera
- Personalizing light and audio levels for specific client needs
- Considering tranquil wall colors and decor
- Avoiding visible clutter within the camera frame
- Ensuring high-definition resolution for the computer and/or smartphone screens
Setting up your practice space will also help make post-treatment care processes easier. This includes note-taking, documenting your sessions, scheduling follow-up appointments, and completing any necessary administrative tasks, including coordinating care with your clients’ other healthcare providers, as needed.
Can special client populations benefit from telehealth-only practice?
As you firm up your workflow processes, it’s essential to keep your special client populations top of mind to ensure the smoothest experience possible for them. For children and adolescents who have a difficult time getting to appointments, telehealth could be the solution they’ve been seeking, due to:
- Greater accessibility
- Increased convenience
- Reduced travel costs
- Consistent, continuous care (especially for clients with complex, chronic needs)
- Ongoing support resources for critical child welfare services
What are some key future trends and opportunities I can explore in telehealth?
Telehealth is just one piece of a larger puzzle: There are several other developing technologies to consider including in your private practice. Once you and your clients get comfortable with this virtual standard of care, consider other advancements that could revolutionize your business, like:
- Virtual reality (VR) is becoming a key innovation in the behavioral healthcare space. By having the unique ability to recreate real-world environments through immersive simulations, VR has shown to be specifically effective in augmenting cognitive-behavioral therapy (CBT).
- Generative artificial intelligence (AI) is quickly ascending into the most discussed technology in the mental health space. A new generation of AI chatbots has become increasingly popular, due to their ability to create human‐like responses and messages back to clients. In this way, AI serves as both a friend and a virtual companion, thanks to the technology’s ability to manage diverse inputs and respond with deep empathy. However, it’s important to note that while these chatbots can be helpful, they should only be used as an adjunct to — and not a replacement for — therapy with a trained provider.
As our lives grow and expand in every direction online, our standards of behavioral care must continue to adapt, too.
