When Thomas Crow began working toward his doctorate in clinical psychology, he was skeptical that certain aspects of therapy could be successfully implemented in a telehealth environment. He wondered if emotions in a patient’s voice or body language, for example, might be more difficult to pick up remotely than if the session were face-to-face.
As he prepares to leave Penn State for an internship in Boston, he has changed his mind.
Crow’s sessions in Zoom went well when the Penn State Psychological Clinic resumed operations about one week after spring break. Dr. Michael Wolff, director of the clinic, said that was all the time it took for the Liberal Arts IT team to get the accommodations in place for the practitioners to offer telehealth.
“Although I don’t see us ever going this way fully, everyone has been surprised how smoothly it has gone. Our administrative staff, our faculty supervisors, our clinical staff and our students, they’ve certainly all stepped up,” Wolff said. “We had some people who had to get a crash course in certain aspects of the technology that they weren’t comfortable in, and the same thing was true with our clients. But it’s been really just flat out surprising how smooth this has been.”
He credited the IT team for paving that smooth path. John Taylor, cyber information assurance analyst, said they were involved in a number of things, from setting up front desk personnel to make and receive clinic calls at home, and preparing devices for staff who didn’t have the necessary equipment to work at home. About a dozen laptops that were no longer needed for a research project and a similar number of brand new all-in-one devices were quickly imaged and had necessary applications installed, including Enterprise Active Directory, Zoom, and antivirus software.
IT collaborated with the Office of Information Security (OIS) to maintain Health Insurance Portability and Accountability Act compliance, since clinic staff needed to remotely connect to electronic health records and billing software.
“A variety of different mechanisms and controls are required to keep sensitive patient data safe and secured,” said Kyle Crain, information security architect with OIS. “Using technology configurations we already had in place allowed us to be able to quickly meet the needs driven by a sudden shift to telehealth scenarios.”
Recent changes that OIS implemented in Zoom also enhanced security, which was important for the telehealth sessions to remain secure.
Crow said some patients were initially wary about having their sessions in Zoom. To address one concern that sessions were indeed private, for example, he worked from a room in his home where the client could see the door was closed and he wore headphones to minimize any chance of information the client divulged being overheard.
Wolff said there were also some guidelines and general recommendations all clinicians needed to follow, particularly from psychological associations and insurance providers, which included the need for stringent informed consent procedures.
“It’s a different informed consent on who can hear the conversation, whether the session is going to be videotaped and recorded, and where that information would go, and so on,” Wolff said. “Across the nation probably one of the most significant changes is that we’ve allowed for a lot of verbal and then documented consents, because it is trickier in a telehealth session to get written consent.”
Along with providing the resources to enable telehealth sessions, Taylor said the IT team didn’t stop its work that has been underway since the beginning of the year to replace the clinic’s two separate billing and health records software systems with a combined solution, DoctorCloud. They are currently working to import the data from the two systems into the new software, and DoctorCloud’s anticipated rollout for the clinic is in June.
Crain said the single solution will be better from a security perspective.
“We are always looking for ways to minimize the attack surface of a variety of infrastructure at Penn State,” he said. “If you have multiple systems running on a network with different security controls, that’s two different systems that could potentially be exploited by an attacker to gain access to data, infrastructure, etc.”
Wolff said when more normal operations return to the clinic and in-person sessions can resume, he believes there will still be a place for telehealth.
As for Crow, he is curious about whether the therapy landscape will change, just as his original thoughts about telehealth did.
“I think I’ve been proven wrong and more might be possible via telehealth than I originally thought,” he said. “Therapy over video wasn’t something that I planned to do with any regularity, but I imagine many others have had the same kind of realization that I’ve had, which is, this is a little bit more possible than I realized.”