- In telemental health, one of the most important attributes is immediacy. And Dr. Thomas Kim is never more than a tap on a smartphone app away from someone in crisis.
“We should never discount the power in our pocket,” the Austin, Texas-based internist and telepsychiatrist says.
Kim is part of the new wave of virtual healthcare providers, forsaking the office, clinic or hospital for a mobile health platform that connects with people when and where they need help. The platform is particularly popular in behavioral health, a fast-growing field in which discreet access to healthcare has become a hallmark for improved care.
Interviewed in Chicago during the recent American Telemedicine Association conference, Kim, who uses a mobile health app developed by Medici (he’s listed as a “physician evangelist” for the company), says the technology helps him provide the “right touches” to patients. Using his smartphone, or an iPad when he’s at home, he can make a HIPAA-compliant connection with someone who might otherwise go into crisis – or turn to medication.
“These are well-timed touches,” he says. “They’re simple, but they’re also very powerful.”
Telehealth and mHealth advocates are touting their technology as a new tool to help the nation’s ever-increasing ranks of people with behavioral health issues, from the adolescent dealing with depression to the adult struggling with a substance abuse issue (and vice versa). These apps and virtual health platforms are often called digital therapeutics, in that they can be used by healthcare providers as treatment in place of medication – an over-reliance of which has led to the ongoing opioid abuse epidemic.
Mainstream healthcare hasn’t fully embraced this technology – that’s why it’s often called disruptive. But Kim, who “likes the fact that our house is on fire” and cheerfully admits that he likes to run toward the chaos, says providers are being compelled to experiment with new things in an effort to improve on a process that isn’t working.
“We are fording that change,” he says.
“Technology is enabling new delivery models,” adds Sandeep Pulim, Medici’s chief innovation officer, who sees mHealth and telehealth being used to either replace drug treatment or, as in medication assisted treatment (MAT), improving medication management.
“Telehealth is about re-imagining,” he adds. “It’s how you make doctors more efficient.”
Kim says he likes the idea of “weaning people off drugs.” Too many people nowadays see drugs as the only form of treatment, he says, and in so doing devalue the power of communication. That’s especially true in mental health, where drugs are used to ease or mask, but can’t help patients overcome their challenges.
For telemental health providers, Kim says, technology offers new hope for treatment, if it’s used correctly.
“I don’t think we are owed anything by innovation,” he says. “These are tools and skills to be mastered in telemedicine. The burden is on the provider like me. Just like physical exams, but mental health exams can be more easily administered over telemedicine applications. But if a provider doesn’t engage in this with the patient – they are at a disadvantage in terms of engagement and building a practice.”
Kim, who assisted in the crafting of Texas’ telemedicine laws, first got into psychiatry during his days at LSU, when he moonlighted as a counselor for juveniles in prison. He now spends half of his time in clinical work, working out of his home, and the other half working with healthcare providers and vendors to improve mHealth and telehealth platforms in telepsychiatry.
He works with everyone from retired military personnel to young prisoners.
“For example, I was able to talk a patient who was grieving back from the ledge during a death in the family,” he recalls. “I modified his medication and then saw him upon his return to Texas. (And) I heard from a juvenile with a shirt wrapped around his neck – he was killing himself in a jail cell. His dad had visited him the jail and set him off. I used a telehealth model to avoid a hospitalization.”
Those interactions don’t happen in the office, with the patient sitting on a couch.
“Kids are naturally under-developed because their brains are not made,” Kim adds. “I am a big believer in therapy and I don’t like giving them a lot of medicine. I would rather see you more frequently in the front end and intervene and help you.”
That means being able to connect within seconds through an app.
“The world we live in as mental health professionals is changing in an unplanned, organic way,” Kim says. “I have continued to reinforce and support patients even during the tough holiday times for them. I have the bandwidth and flexibility to do things even during these times when other doctors would not be available.”
Human beings are social by nature, Kim says, so mHealth and telehealth tools and platforms have a unique opportunity to meet people where they’re most comfortable (and vulnerable). Practitioners gain unique insights from communicating with their patients outside the office, and are able to learn more about the people the treat and the methods to treat them.
“This is not exceptional or peripheral to healthcare,” he says. “This is healthcare. This is the right provider offering the right care at the right time.”