Call it the great technology experiment of 2020-2021. In just days, McLean—along with most other mental health care providers—transitioned from delivering care almost entirely in person to treating a majority of patients via videoconferencing or phone.
“We had been baby-stepping our way toward telemedicine. Then suddenly everyone had to do it, from the most to the least savvy patients and providers,” said McLean’s Chief Medical Information Officer Alisa Busch, MD, MS. “It’s been an amazing journey.”
One of the silver linings of the forced pivot to tech-enabled care has been the ability to extend access in new and more flexible ways.
“For populations like older adults, where no-shows tend to be higher because of obstacles, virtual care has eliminated these barriers,” said Ipsit Vahia, MD, associate chief of McLean’s Division of Geriatric Psychiatry and the hospital’s director of Digital Psychiatry Translation. “In our program, we’ve been seeing 30% more patients than before the pandemic. Our no-show and last-minute cancellation rates have dropped to almost zero.”
Hospital-wide, telemedicine has helped on the staff side of the equation, too. Clinicians can conduct after-hours admissions or consultations via video when their specific expertise is needed.
In addition to making McLean’s services more accessible, there have been other technology windfalls, according to Busch.
Seeing patients in their home environments provides important insights during therapy. Patients with obsessive compulsive disorder can do their “homework”—for example, engaging in an activity that triggers their symptoms to gradually lessen the impact—with their therapist watching and providing guidance. Therapy with family members in different locations becomes a cinch with Zoom.
And early concerns about telemedicine never came to pass: staff worried unnecessarily that certain patients would have trouble navigating the technology.
Technology Support Eases the Transition to Virtual
Some patients in the geriatrics division, however, did need extra support, which was revealed in a survey done early in the pandemic. Two research assistants (RAs) from Vahia’s program were reassigned as “virtual care support specialists.”
“Research was on pause at that time, so our RAs were available to make this shift,” explained Vahia. “We created protocols for them to reach out to patients, set up meetings to teach them about Zoom, and offer practice sessions so patients were proficient by the time of their appointments.”
Across the hospital, programs tailored technical assistance to their patient and staff needs, and most designated a point person as the technology lead.
The hospital distributed best practices for handling things like admitting latecomers in an online group environment or privately messaging patients who appeared to be in distress. Clinicians were encouraged to reflect with patients on the impact of telehealth on their treatment.
“We want to make sure we’re meeting patients’ needs—asking them what’s working and not working,” said Busch.
And what’s the future of telemedicine at McLean once the pandemic is in the rearview mirror?
“I think virtual care is with us long-term,” said Chief Information Officer Kara Backman. “It adds a lot of value to the clinical care tool kit, but it’s not for everyone. Individual programs are thinking deeply about when and with whom to use it.”
Using Virtual Reality With Older Patients
Vahia is bullish on the potential of virtual reality (VR) as a therapeutic tool in treatment.
Vahia is using VR in mindfulness groups for anxiety and depression. For example, instead of a therapist narrating a walk in a forest, patients might wear VR headsets to immerse themselves in the experience.
Similarly, virtual reality tools can be helpful in reminiscence therapy for patients with dementia—taking them to a favorite location, such as a park where they had picnicked with family—to lessen anxiety and depression, stimulate memory, and increase resilience and feelings of joy.
“We’ve found that targeted use of VR can enhance the impact of well-established therapies like psychodynamic therapy by making these interventions more experiential and immersive,” said Vahia.
Vahia recently worked with an older patient who was having difficulty tapping into childhood memories. Using VR, she visited her childhood home, her elementary school, and her dad’s business. “Recreating the sense of being there unlocked emotions and memories that she wasn’t able to access before,” said Vahia.
Vahia’s work has been of particular interest to Eric Warren Goldman, chairman and CEO of the Extended Family Office Group, and a supporter of technology research at McLean. Goldman recognizes that telemedicine has been an enormous boon for elderly patients who cannot travel easily or safely to appointments.
“I see the value of the gold-standard and world-class preventative and treatment options at McLean—for my family as well as for the Extended Family Office Group,” he said.
“I have been impressed by Dr. Vahia’s use of cutting-edge technology for geriatric patients. He has been prescient in implementing technology to support in-person care and to help families manage the best in-home care, for as long as possible. I have seen firsthand the superlative care that McLean provides. My mother has had the tremendous benefit of years of great care by Dr. Vahia and his team.”
“Eric’s support has been transformative,” said Vahia. “He has been involved and invested in ensuring the highest quality in-home care for his mother and has a keen understanding of the value of using technology to enhance care for others like her.”
Even early adopters like Vahia understand the limitations of high-tech tools. “We are realizing that technology is at its most effective when combined with high-quality in-person care,” he said.
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