But anyone looking for data to support adopting a telepsychiatry program might be hard pressed to find any.
According to a literature review appearing in the December 2003 issue of Psychiatric Services (54:1604-1609), methodologically sound studies of telepsychiatry are infrequent, despite the rapid increase in information about the technology.
The authors of "Recent Advances in Telepsychiatry: An Updated Review" examined 68 studies published between March 2000 and March 2003. Overall, they found that the studies supported telepsychiatry as a useful means of conducting assessments and improving a patient's clinical status, but that "only a limited number of empirical studies have been reported over the past three years."
The review concluded that the field needs "reliable baseline data gathered before the implementation of programs, evaluation of clinical outcomes, randomized experimental design with appropriate control groups, cost analyses, and determination of the effectiveness and efficacy of telepsychiatry for specific patient populations."
Testing the Limits
The OMH project's one ongoing cost is for broad bandwidth phone lines. Telepsychiatry systems use Integrated Services Digital Network (ISDN) lines, which offer far more confidentiality and reliability than would an Internet connection and allow for television-quality video and audio. Because the OMH has purchasing power, the project pays only $104 a month for each ISDN line and a charge of only 16 cents per minute as a usage fee, so that a one-hour consultation costs less than $10.
The state has agreed to fund the cost of the lines to the 12 county sites indefinitely, and the state has picked up the tab for the bridge connector fee that links the OMH system to the prisons' telemedicine system.
The technical quality of teleconferencing systems is quite good, Hyler said, and is mostly a function of line speed rather than hardware. Each ISDN line operates at a speed of 128 kilobytes per second (KBps). Together, three lines give the user 384 KBps, which is more than adequate for full-motion video and flowing audio with minimal delay. Newer equipment would be able to achieve the same effect at 256 KBps, meaning that only two ISDN lines would be needed.