American Telemedicine Association Releases New Guidelines for Telestroke and Child/Adolescent Telemental Health Services

VCBeat has learned that on April 10, the American Telemedicine Association (ATA) released new practice guidelines based on clinical and empirical research. Although there may be considerable variations in telemedicine policies and reimbursement models across different states, standards for certain specialty types of telemedicine should remain consistent.

This guideline outlines the foundational knowledge and operational references for two specialties: stroke care and child and adolescent mental health. Developed collaboratively by experts and industry leaders, the guideline also incorporates input from telehealth practitioners, health systems, provider groups, healthcare companies, medical boards, and government agencies. Both stroke treatment and mental health services are significantly impacted by telemedicine; consequently, certain treatment protocols may require more rapid feedback and be implemented before sufficient evidence supporting their use has been gathered.

Jonathan Linkous, CEO of the ATA, stated in a press release: “In response to the growing demand for telehealth, the new guidelines promote the scientific advancement of telehealth and ensure consistent, high-quality care for patients who need improved health outcomes and life-saving interventions.”

Telestroke Treatment Guidelines provide standardized parameters to support assessment, diagnosis, and remote consultation, which the ATA refers to as “widely used” telemedicine.

This guideline focuses on the acute phase of stroke, encompassing prehospital and in-hospital emergencies involving the cerebrovascular nervous system. These guidelines describe an audiovisual communication network and a teleclinical service system that provides recommendations on surgical interventions, disease control, management, and cost considerations for stroke. These interactive experiences deliver expert knowledge to both remote and on-site healthcare practitioners, facilitating the provision of acute care measures for patients with acute ischemic and hemorrhagic stroke syndromes, thereby enhancing clinical practice and improving treatment quality and metrics.

These guidelines apply exclusively to telestroke services and do not prescribe or provide recommendations for comprehensive clinical protocols in the care of stroke patients. Instead, they focus on unique aspects of facilitating bedside and remote care through the telestroke model.

“Telestroke programs typically share similar goals, including improving patient outcomes, reducing costs, and optimizing resource utilization; however, the structure of each program may vary depending on organizational objectives, available technology and human resources, as well as the type and scale of acute care facilities, leading to variations in the delivery of clinical services,” wrote the authors of the new practice guideline.

The ATA standards avoid using the best management, clinical, and technical guidance protocols, which may be particularly useful for telestroke treatment, as more people are experiencing strokes in addition to those receiving care at specialized treatment centers.

Therefore, telemedicine can particularly benefit rural or low-income populations who lack access to specialized treatment services. Dr. Bart M. Demaerschalk, the director overseeing telemedicine services at the Mayo Clinic, stated in a press release, “The telestroke guidelines are the result of synthesizing the best diagnostic evidence, clinical experience, and consensus from numerous experts.”

Clinical Guidelines for Child and Adolescent Tele-Mental Health (CATMH): A Guide to Treating Mental Health Disorders in Children and Adolescents Amidst Widespread Lack of Treatment Options. CATMH services deliver real-time videoconferencing through licensed healthcare providers to help improve the mental health of children and adolescents. These guidelines address three aspects of service delivery: management/oversight, clinical operations, and technology design and architecture.

Basic guidelines for telemental health apply to popular Internet-based (also known as “consumer-grade”) videoconferencing, and guidelines have also been issued for traditional telephone-based high-definition, point-to-point (also known as “standard-grade”) videoconferencing. Telehealth providers are advised to refer to the overarching guidelines. Furthermore, as telehealth care spans across age groups, these guidelines include four new sections: Ethical Standards; Digital Lifespan Health; Clinical Supervision; and Future Directions.

In accordance with general practice guidelines, the CATMH guidelines focus on interactive video conferencing between two or more sites, with an emphasis on providing clients—including those receiving consultation, collaboration, and direct services—with the same level of care. Direct services encompass a range of psychological and behavioral health interventions, including prevention, early intervention and coping strategies, treatment, and maintenance/support. These guidelines apply to the use of both standards-based and consumer-grade video conferencing connections. Emerging products are blurring the distinction between standards-based and consumer-grade approaches by offering internet-connected, consumer-oriented platforms that also provide standards-based interoperability.

The guidelines also note that mobile health (mHealth) can be applied to Computer-Assisted Tele-Mental Health (CATMH) through wireless devices and mobile phone technologies. mHealth delivers CATMH services via consumer-grade hardware and cloud-based video conferencing solutions, thereby enhancing mobility for both patients and remote healthcare providers. Although telemental health services may incorporate various technological approaches, telemedicine, store-and-forward telehealth, e-health, and non-video components of healthcare fall outside the scope of these guidelines. Other areas excluded from the scope include online interactive coaching, home monitoring, mobile applications (apps), wearable technology, email communication, text message reminders, and social media.

“Expanding access to mental health services for a growing number of young people is often the rationale for implementing telemental health programs,” the guidelines note, adding that such programs have seen high adoption rates and contributed to improved health outcomes for families. “Due to their frequent use of and proficiency with technology, telemental health services are particularly well-suited for adolescents. The technological literacy of patients, families, and providers is rising sharply, with improvements among adolescents driving overall household digital literacy.”

Furthermore, in some regions, service providers with little to no training in adolescent mental health are prevalent. To bridge the urban-rural treatment gap and achieve equilibrium, the ATA developed guidelines for child and adolescent mental health, providing clinical information on these services to be delivered by licensed healthcare providers in these areas.

“Given the growing need for trained providers of behavioral health services for children and adolescents, this demand is unlikely to be met in the foreseeable future; thus, telemental health services offer an effective means of increasing access and improving the quality of behavioral and mental healthcare,” said Professor Kathleen Myers, Professor of Psychiatry at the University of Washington and Director of Telemental Health at Seattle Children’s Hospital, in a statement.

However, at present, not everyone seeking care can access remote mental health services. The organization points out that the Federal Communications Commission’s “2015 Broadband Progress Report” shows inconsistent development across counties in advanced/high-quality synchronous voice, data, graphics, and video services for telehealth platforms. Through these guidelines, they aim to standardize this practice, thereby driving technological advancement throughout the United States.