Clinician Corner: How Dr. María López-Rosario Keeps Children and Adolescents Engaged in Virtual Care

Iris clinicians are at the heart of what makes our organization such a special place to work. That’s why we’re turning the spotlight on the amazing work they’re doing every day. This month, we’re sitting down to talk with Dr. María López-Rosario.

Q. How did you find Iris and decide you wanted to be an Iris provider?

A. I was working at a pretty terrible job in community psychiatry. I’ve always loved community psychiatry, and that’s what I wanted to do. However, at that point in my life, I needed more flexibility. So, I reached out to my residency colleagues, and two of them were working for Iris, and they are one of my best friends from residency. I trusted them and applied, and here I am after four years, and one of them is still working for Iris, too. It feels like a flexible, comfortable place for them and has been for me, too.

Q. How does telepsychiatry compare to in-person work?

A. That question was probably the biggest one in my mind before I did telepsychiatry because, before Iris, I had never done telework. It is different in the beginning, but it feels like it’s not different once you start, and once you begin an appointment and get to know the person, it feels like the computer and the camera go away. Because I deal with mostly children and adolescents, sometimes the little kids can be a little hard to engage in the camera because they’re so active and energetic. You need to figure out a way to engage them.

For example, I’ll change my virtual background. If I know I have a seven-year-old, I’ll put a Minecraft background on, which makes it easier to get started. It’s different because you might need to put a little more work into engagement, but, in the end, once engagement and rapport are built, the computer screen’s camera really goes away.

I’ll use Minecraft, Pokemon, and Unicorns – as long as you have something in vogue and trendy with the kiddos, it’s fun, and they’ll engage. It is a way to get to know them, too. It’s just a way to personalize the meeting.

Q. How do you foster connection with patients virtually?

A. In general, I think technology and virtual environments are what kids and adolescents engage with these days. Because this population is the majority of the patients I see, I don’t think it’s hard at all, especially for adolescents. They even sometimes prefer it. If they have a severe anxiety disorder, they might put the camera away. I’ve even had kids I see face-to-face write something in the chat. Like, “I’m embarrassed to tell you this, but it’s not as personal if I just write it out.”

I usually try to see the patient alone, but if the parent is around, they might say, “Okay, I’m going to write this in the chat because I don’t want anybody to hear it.” And they’ll write something like, “I have a girlfriend.” It’s more private and chat doesn’t make it personal. I’m still getting all the information in whatever way they like to give it to me.

Being virtual gives you a lot more options than being in person.

Q. As a healthcare professional, how do you manage work-life balance?

A. Work-life balance is one of the reasons I chose telehealth. I think work-life balance is super important. Because my clinic starts a little later in the day, I can get up pretty early, drop my daughter off at daycare, drop my son off at school, work out, shower, and then connect. I have a few hours that I actually take care of myself a little bit. Of course, I love vacations, and I love food. So I always take my vacation, and I go traveling. I go out to eat. I’m with my family. And the fact that I can disconnect and just kind of be here, it’s helpful to foster that work-life balance.

Q. What is the most rewarding part of your job?

A. It’s a hard question because my work is so rewarding overall. It can be difficult. It’s very heavy sometimes. We kind of swallow and absorb a lot of the problems that are happening with our patients, but there’s so much reward in seeing kids and adolescents thrive and become successful adults.

Whenever I get that question, a particular patient always comes to mind. I had been working with a patient who was about 14 when I first started treating her. She has pretty significant anorexia nervosa. She was a very smart, bright child, but her brain was starving. So, she was doing really poorly in school. She sometimes didn’t have energy.

Then whenever we started treating her with medication on my part, therapy from the team, and support altogether, she slowly regained weight and started being herself again. I treat community mental health, so this population is poor, underserved people. At the end of the day, she was able to graduate, and she was given a scholarship to Harvard. It was such a big experience. It was not only that she got better from the anorexia, but she was confident, independent, and able to get out in the world, and have such an amazing accomplishment. The success of my patients is the most rewarding.

Q. What do you love about working with Iris?

A. Iris is really the best company I’ve ever worked with. It’s probably been the only company that treats you more as an individual rather than as, you know, “you’re just one of the doctors here.” Whenever I was one or two years in, my manager sent me an amazing gift. She sent me a drawing of myself in a cape. In one hand, I was holding a pizza slice, and the other was holding a weight. It was so heartwarming because she knows me. She knows I’m a foodie, and she knows I love to go out and take care of myself, too.

Then, alongside the picture was a charcuterie board shaped like Puerto Rico. I am from Puerto Rico, and she knows I am super proud of my Puerto Rican roots. I don’t think even someone in my family would give me such a significant gift. I think the details are key. I don’t think any other company would care about that.

Q. Why do you think telepsychiatry is important to the future of mental healthcare?

A. I think it’s paramount and essential — not only telepsychiatry but telemedicine work in general. We learned how important it was during the pandemic. The fact that you can stay safe, not expose yourself to COVID, and click and connect with quality care. That was lifesaving for many people, especially underserved people. The clinic that I work with is in Los Angeles. There’s a huge gap between the underserved population versus the affluent people. Most patients don’t even have a car or money to take a bus.

I think telepsychiatry, and telemedicine in general, have built a very strong bridge. The care that wasn’t even being provided before is now in the palm of your hand or your home office. Mental health is really a thing that’s getting worse. We’re getting more mental health problems and psychiatric illnesses, and the fact that people can click and get help decreases stigma, increases connection and the personalization of work. It’s here to stay. I don’t think it’s going to go away because if it does go away, it’ll hurt the health of the country.

Q. What advice would you give to someone new to telepsychiatry?

A. I would just say jump into it. It seems scary at first because of the lack of connection with colleagues. You are in either your home or office, probably by yourself, that part is scary. My advice would be to stay connected with either your fellowship bodies or residency bodies – you can even stay connected virtually. You can even do super visual supervision. I think my advice is not to lose that connection with your location and your local colleagues.

At Iris, we believe our providers should be respected, valued, and applauded for the work they do, and we couldn’t be more proud to say, “thank you” to our very own Dr. López-Rosario. If you’d like to learn more about working for Iris Telehealth, contact us today.

How Bridge Care Services Help Hospitals Address Short-Term Mental Health Needs

Ensuring patients with a mental health diagnosis get the best short-term care possible after their hospital visit is essential. In fact, clinical best practices and various guidelines recommend that 100% of patients leaving the ED with a behavioral health diagnosis should receive follow-up within the first seven days. However, that process is done less than half the time nationally.

For health systems, solutions like Bridge Care Services can help deliver the quality, short-term care needed to support effective patient outcomes and experiences. But, how does bridge care work, and how does it help ensure patients get the care they need in a way that’s financially and organizationally sustainable for health systems? Keep reading to learn more.

Want to jump ahead? Feel free to navigate this piece using the table of contents below:

The challenges hospitals face with short-term behavioral health care
Why patients benefit from short-term care after discharge
The power of high-quality care and support after discharge
Short-term behavioral health care in action
Where Iris Telehealth fits in

The challenges hospitals face with short-term behavioral health care

When it comes to meeting the needs of patients with behavioral health diagnoses, hospitals, and health systems face challenges related to behavioral health staffing and the ability to provide timely, efficient care. While many patients need care, there aren’t enough providers to facilitate treatment. Currently, hospitals face staffing challenges for case managers, licensed clinal social workers (LCSWs), psychologists, and psychiatrists.

Additionally, pulling together a safe discharge plan can be exceptionally challenging for case management teams, especially if the patient isn’t plugged into an outpatient team. If patients can’t access effective follow-up care after discharge, hospitals may experience an increased risk of readmission, and patients may be more at risk of worsening symptoms. For example, if patients aren’t set up with a provider who can help with medication or therapy (or both) upon discharge, they may risk relapse of unsafe behaviors and medication non-compliance.

Despite these challenges, setting up a solution like Bridge Care Services, for short-term care can help promote positive patient outcomes. This solution fills short-term gaps in ambulatory and post-acute behavioral health care by accelerating access to specialists, achieving measurement-based outcomes, and optimizing reimbursement for a financially sustainable behavioral health program.

Why patients benefit from short-term care after discharge

Patients who enter the post-acute referral queue need care that’s more efficient than what’s offered in traditional outpatient care. These patients are at particularly high risk when they move from intensive acute care to wait for their next outpatient appointment. Ideally, these patients should be seen quickly upon discharge. However, due to a lack of resources and extensive waitlists, they may end up waiting for long periods to see an outpatient provider or may need to return to their primary care provider for a follow-up appointment.

When these patients leave the hospital system, they’re often starting medications or getting medications adjusted. These patients need close follow-ups with labs to ensure they’re tolerating their medicines at the right dose.

Additionally, there are a lot of stressors that come with being discharged. For instance, the hospital creates a very structured environment for the patient where they receive three warm meals daily, have housing, and have supportive people surrounding them. However, when discharged, they may be sent back to the environment that initially triggered them, or did not optimize structure and support needed for on-going recovery and healing.

Treatment isn’t complete once a patient is discharged. While their symptoms may have improved with their current treatment plan, they must be continually assessed, monitored, and potentially adjusted at a lower level of care. All of these considerations make short-term care essential.

The power of high-quality care and support after discharge

A dedicated bridge care program solves access at scale. When a hospital or health system has an extensive referral queue, this solution helps patients get care in a timely manner. Bridge Care Services bridges the gap with short-term care and helps ensure patients can be safely managed by their primary care provider or can safely land with a long-term behavioral health provider.

Here are a few keys to success that Bridge Care Services offers:

  • Financially sustainable programming: Hospitals and health systems can have a financially sustainable program by leveraging a billable navigation assessment and driving top-of-license care.
  • Top-of-license work: At Iris Telehealth, we’ve seen health systems leverage psychiatrists for visits that could be handled in a lower level of care. In some cases, primary care providers refer patients to psychiatrists who could be seen by a therapist or a psychiatric mental health nurse practitioner (PMHNP). As a part of the navigation assessment within bridge care, this solution helps ensure everyone is working top of license.
  • Improved clinical care and outcomes: By providing quality, timely care to patients, bridge care improves patient symptoms, reduces hospitalization and escalation of care, and ensures patients are getting better sooner and don’t drive escalations into high acuity levels.
  • Turnaround time for follow-up visits: Bridge care helps ensure visits happen quickly and make it a quality measure. When assessing, the rule of thumb is to see a patient within seven days of discharge.
  • Pool of resources: This solution helps the inpatient team know they have a pool of resources for the patient when they’re trying to arrange follow-up appointments. If there’s a gap, these resources ensure the patient has a safe landing out of the hospital/outpatient setting.
  • Warm hand-off for patient care: Effective communication during the hand-off is crucial for success. At Iris, we use the same electronic health record (EHR) as the healthcare organization, and can help ensure the assessment and notes are documented for the primary care physician and therapist.. The hand-off ensures seamless communication and updates the next provider on the treatment plan, including medication adjustments and patient progress.

Short-term behavioral health care in action

Effective short-term care requires dedicated providers who can deliver appropriate care to patients for approximately 90 days following the initial assessment. For patients who require medication management, effective short term bridge care can include three total visits – one 60-minute initial consultation and two 30-minute follow ups. For those requiring therapy services, many patients require six sessions over the 90 days.

By working with a telehealth solution that is technology-neutral and can integrate into an organization’s patient outreach process, healthcare organizations can seamlessly ensure patients receive the short term care they need to address their mental health conditions and develop treatment plans as needed.

Here’s what people are saying about utilizing Bridge Care Services at their organization:

“One of the biggest advantages was gaining access to a national pipeline. It can be tough to recruit in a rural market, and now we can get talented providers in the door much quicker than before. As a result, we got 20 or so highly talented, very bright and motivated providers on our team in a matter of months.”

Benjamin C. Gonzales, operations manager II, virtual care, at Geisinger Health

Where Iris Telehealth fits in

Bridge Care Services helps ensure patients can manage their symptoms and reach an improved state where they can live a happier, more balanced life. If you’d like to learn how you can best support the patients seeking mental health care in your hospital or health system, contact us today!

How to Advance Mental Health Access with Community Resources and Collaboration

When working with populations facing barriers related to social determinants of health, utilizing resources in the community, combined with telehealth, can help connect them to the behavioral health treatment they need.

Jump through the table of contents below and learn how to increase access to mental health services:

The role of social determinants of health in behavioral health care
Types of partnerships your organization can leverage
How remote providers can connect patients with local resources
Where Iris Telehealth fits in

The role of social determinants of health in behavioral health care

Access to quality behavioral health care is vital to a patient’s health. However, many individuals and families struggle to get the care they need due to social determinants of health (SDOH). Here are a few ways SDOH can impact mental health and quality of life:

  • Finances: More than 1 in 5 patients need assistance to afford their prescription medication. Medication adherence can be a challenge for uninsured patients with costly medication or for those who have insurance that doesn’t cover prescription costs. In some cases, patients have to choose between paying for groceries, their prescriptions, or rent when faced with high prices.
  • Housing Insecurity: Patients who move around a lot due to housing insecurity can face more challenges receiving consistent mental health care. For example, patients often need a home address to qualify for special assistance programs, which can affect their ability to afford treatment. Additionally, many services patients spend time applying and preparing for become obsolete without housing stability. For children, moving around a lot can be disruptive to their education.
  • Food Insecurity: Food insecurity is associated with a higher risk of anxiety and depression. When patients can’t feed themselves, their physical and mental health is impacted. Malnutrition leads to a greater risk for chronic health conditions, which can also increase the risk of depression and other behavioral health care challenges.
  • Education: Receiving immunizations can be a significant barrier for undocumented children, as they often require showing proof of citizenship. When children are forced out of the school system, they lose out on many resources that the education system provides. A lack of education can impact social support, health literacy, and can contribute to poor mental health outcomes.

Let’s take a closer look at the type of partnerships organizations can leverage to help make a positive impact on patients experiencing SDOH.

Community resources to leverage for social determinants of health

Partnering with stakeholders and organizations in your community to fund programs can have many benefits for your patients. While many of these partnerships are non-traditional, innovative efforts through collaboration can improve healthcare outcomes. Here are just a few examples of organizations for potential partnership opportunities:

  • Government: Local governments serve as a vital resource for external funding. They can advance health equity by sharing valuable data on which populations in your community experience worse health outcomes. This information can give insight into the distribution of resources and what resources are available. Additionally, by attending meetings hosted by local government, healthcare leaders can become thought leaders and key stakeholders in the community.
  • Faith-based organizations: Churches, temples, and other religious congregations can improve care delivery and quality of health care for many community members. A religious congregation provides a place to access treatment and preventive services without fear of discrimination or government interference. This advantage is especially helpful for immigrants or refugees who have established trust within their religious community. For example, sometimes child and adult immunizations can be offered at a community’s local faith-based organization without a need for IDs and other paperwork.
  • Educational organizations: Universities, colleges, and schools are a great way to disseminate health and mental wellness resources to the community. Coordinating with schools could look like hosting events together, directly offering mental health services on campus, or developing joint programs to promote student access to health care. Workshops and seminars allow an excellent way to educate students on relevant mental health topics.
  • Mission-based organizations: These kinds of organizations include National Alliance on Mental Illness (NAMI) or Mental Health America (MHA) for broad mental health resources, the Trevor Project for LGBTQIA+ youth to support specific underserved populations, and more can expand your organization’s knowledge base and your network. For example, partnering with a mission-based organization that helps veterans can be an effective way to connect with veterans who need mental health care.
  • Community organizations: Food banks, social services, and other community organizations can provide beneficial partnerships. Additionally, connecting with cultural community organizations allows providers to share mental health resources that meet the specific needs of that community.

It’s also essential to attend community events and encourage your on-site providers to do the same.

How remote providers can connect patients with local resources

Telehealth meets SDOH head-on by connecting patients with providers regardless of where they live. Having a provider that provides specialty care, while also helping their clients stay connected with local resources, can help improve outcomes that have the potential to be impacted negatively by social determinants of health.

For remote providers, staying connected to the community they serve can be achieved by being flexible, creative, and proactive in their approach to care. As a healthcare organization, you can encourage your providers to stay connected with their patient’s local resources.

A few ways your providers can achieve this connection is through signing up for newsletters, following local government on social media, and staying informed on the most recent information and events in the community. While telehealth can make providers physically incapable of being there, they have options to connect with their community and stay in the know virtually.

Where Iris Telehealth fits in

At Iris, we partner with communities in need of mental health resources. Through partnerships with community organizations and stakeholders, healthcare organizations can build programs and services dedicated to address the unique needs of the community they serve, including the implementation or improvement of telepsychiatry services. Partnering with Iris allows members of your community to receive the care they need when they need it. Contact us today if you would like to learn how telepsychiatry can help your community.

EMR Best Practices for Remote Providers

Every healthcare organization has to strike a balance between ease of use and security when it comes to their EMR. And, if an organization is utilizing a virtual solution, like telepsychiatry, there are several special considerations to keep in mind.

Thankfully, there are best practices your organization can implement to ensure your teams are set up for success.

Top five EMR best practices for new users

Whether you’re bringing a remote provider onto your team for the first time or you’re expanding your virtual services, here’s what you can do to help providers get comfortable with your EMR.

  1. Assign a dedicated super user: Training in the EMR is essential. Assigning a dedicated super user gives a provider someone to lean on for immediate support. If a super user isn’t available, allowing the provider to shadow a peer who offers advice and shares templates can also be beneficial.
  2. Provide on-going training: EMRs vary in complexity and can dictate how much training is required. However, having a training plan in place can help create a better experience for patients and providers. Additionally, ongoing refresh training and e-learning opportunities can be helpful and fit nicely into a provider’s schedule.
  3. Conduct a dry run: For healthcare organizations, it’s essential to consider what processes you have built around the EMR and how much your providers know about these processes before they begin using the tool. Conducting a dry run and creating practice spaces for providers can help drive success in the EMR. At Iris Telehealth, our providers go through an entire test run and learn who they should call and what they should do in an emergent situation.
  4. Prioritize the provider experience: Pajama charting is the work in the EMR that happens after clinic hours. As an organization, it’s important to keep track of the amount of pajama charting a provider conducts. If they’re having trouble completing their charting during the day, it’s an excellent opportunity to reach out to them and better understand their experience.
  5. Provide templates: For telepsychiatry, making templates available is crucial. For example, having templates available for psychiatric evaluations can be greatly beneficial. While general templates can be helpful, they’ll likely need to be tweaked for behavioral health usage.

The key to best-in-class EMR support

Supporting your remote providers is essential to their experience of your EMR. When choosing a telehealth partner, one important thing to consider is whether or not they facilitate IT support for their providers.

At Iris, we’re technology-neutral and can seamlessly integrate into your technology. We also facilitate 24/7 IT support to our providers. Because we’re accustomed to the wide variety of equipment and EMRs on the market, we’re well-versed in the types of problems that might occur. Whether it’s an issue with the VPN or the password, we help reduce the frustration that comes along with technology.

Along with provider support, it’s also important to ensure patients have technical support available. For example, if a patient can’t log into their telehealth appointment, it can create another barrier. This barrier can stop them from getting the care they need. That’s why having an effective consumer workflow is crucial.

Considerations for clinicians using the EMR remotely

For clinicians getting familiar with a new EMR, it can be helpful to know what to expect. It’s useful to have insights into the laws, communication, and other patient interactions.

  • Get familiar with badge laws: For healthcare workers, becoming familiar with state-by-state badge laws can be greatly beneficial. For instance, some states require clinicians to wear a badge that displays their name and credentials. These states may also require providers to show their badge to the patient and have it displayed throughout the call.
  • Ensure patient consent: Another thing providers should keep in mind when interacting with patients virtually is ensuring consent. Consent laws can vary by state. Some states may require different language around consent or consent to be visible to the patient within the telehealth application.
  • Communication is key: Generally, the same rules for in-person care also apply to virtual care. However, one key difference is eye contact. While in-person, the patient may intuitively understand that the provider is looking at their computer to take notes, this action may not be clear virtually. That’s why it’s vital for providers to be explicit and let the patient know they’re looking away to take notes. Training and templates can also help providers become better at charting and improve patient connection.

Where Iris Telehealth fits in

With the right processes in place, your telehealth provider should seamlessly integrate into your team, into your workflows, and successfully navigate your EMR. And for them, using the EMR should be no different than if they were physically present on-site. If you’re interested in integrating a telepsychiatry solution into your organization, Iris can help provide the support you need to get started. Contact us today to learn more!