Hostage crisis illustrates need for updated telehealth protocols

When former Army sergeant Robert Anthony Quinones took three staff hostage at the Winn Army Community Hospital at Fort Stewart, Ga., last year, he said he wanted to bring attention to what he considered substandard mental health services for veterans.

A report published in Stars and Stripes last Thursday--nearly a year after the incident--reveals a new detail on what pushed Quinones to the edge: two short telehealth sessions were among the last psychological treatments he received before he snapped.

The Stars and Stripes report strongly implies that Quinones felt the telehealth services didn't provide the level of care he required. "Despite his doctor's urgent recommendation, the Army failed to send him to a Warrior Transition Unit for help," the article says. "The best the Department of Veterans Affairs could offer was 10-minute therapy sessions--via videoconference."

It's an article that all hospital execs who provide telehealth should read. To be fair, it's clear that Quinones' problems went far deeper than simply being dissatisfied with having telehealth visits rather than in-person counseling. His history of post-traumatic stress disorder, multiple medication regimes, alcohol abuse and other problems go back years, according to WSAV TV.

But the new reports made me pause, and I hope they will make hospital telehealth professionals take a moment, as well. As telehealth expands at an exponential rate, this may be an important time to stop and think about your protocols for choosing patients for telehealth and evaluating their satisfaction with those services. In truth, the Stars and Stripes story wasn't an indictment of telehealth as a modality, but rather of its use in the treatment of a very disturbed young man.

I talked with Jon Linkous, executive director for the American Telemedicine Association, about the lessons telehealth providers might take from the Quinones story, and his message was simple: Hospital policies for when (and when not) to use telehealth should be reviewed regularly. "Telemedicine is evolving all the time, and we're learning all the time. The guidelines that are out there should go through revisions all the time," he tells FierceMobileHealthcare.

A few policies that this story might prompt you to review:

  • Which patients are appropriate for telehealth? While telehealth technology is experiencing general success these days, it's important to remember that not all patients are appropriate candidates for remotely delivered care. In this case, the story indicates that on a scale of 1 to 1000-plus--with 200 to 999 indicating the soldier should be transferred to a special "warrior transition unit" for specialized care--Quinones scored higher than 2,300.
  • How to determine if the patient is comfortable with telehealth as a primary counseling method. In the Stars and Stripes story, Quinones' indicates he was "surprised" by his first tele-video counseling session, and perceived that at least one of his two sessions was primarily to increase his medication dosage. Most hospitals have patients sign a release form indicating their choice for telehealth, but with tele-services expanding, it might be time to re-think how that message is delivered.
  • Whether providers have a consensus on appropriate treatment modalities. ATA has guidelines for various telehealth services, but it's having those vetted by medical societies in a variety of specialties. It makes sense to re-visit the issue of telehealth, and any lessons learned from your ongoing program, with your medical staff. Discuss whether certain diagnoses are problematic via telehealth, which conditions seem to respond well, etc.

At the end of the day, telehealth may not have been the true trigger for Quinones' crisis, but the part it did play could serve the industry well if it encourages practitioners to evaluate, revise and update their protocols accordingly. - Sara