NEW CHALLENGES -- NEW FRONTIERS

Having retired from U.S. Senator Daniel K. Inouye's staff after 38+ years, I am beginning my new career as a faculty member at the University of Hawaii Schools of Nursing, Law, and Pharmacy.  The 21^stcentury will be an era of interdisciplinary collaboration, with educators and clinicians being actively encouraged to leave their historically isolated "silos" and engage in cross-disciplinary activities.  What better place to spend the next decade?  This will also be a time for capitalizing upon the exciting opportunities provided by the advances occurring almost daily in the communications and technology fields.  Electronic medical records, telehealth (telepsychology), and data-driven effectiveness comparisons across patients and populations will become the norm.  President Obama's landmark Affordable Care Act (ACA) places a high priority on patient-centered primary care, prevention and wellness activities; as well as providing the various States, such as Hawaii, with considerable flexibility to craft the health care environment which best fits their unique needs and strengths.  HPA has a major responsibility to be "at the table" during these crucial deliberations, as APA Practice Directorate Katherine Nordal has so elegantly proclaimed at the annual State Leadership conferences.  Being personally involved in crafting the future of the profession is yourresponsibility.

            The Administration (HHS) recently announced that the number of hospitals utilizing health information technology (HIT) and electronic health records (EHRs) has more than doubled in the last two years from 16% to 35%, with 85% of hospitals expecting to accept HHS's incentive payments by 2015.  This past January, CMS provided $519 million to eligible providers.  At the time that the President signed his Economic Stimulus legislation, providing $19+ billion in incentives for utilizing HIT, only 5% of physicians had fully functional EHR systems – the goal is 90% by 2019.  This evolution is expected to ultimately result in afundamentally different health care environment.  One which will no longer take on average 17 years for new scientific knowledge to be incorporated into practice.  It will have a dramatic impact upon the practice of psychology and highlights the importance of licensure mobility, as 24/7 consultations (for example with schools of pharmacy) become readily available, and today's geographically imposed barriers are no longer considered relevant.

            The Joint Task Force for the Development of Telepsychology Guidelines:  This effort is a joint venture between APA, the Association of State and Provincial Psychology Boards (ASPPB), and the APA Insurance Trust, and is co-chaired by Linda Campbell (APA) and Fred Millan (ASPPB).  The Task Force (TF) members have backgrounds, knowledge, and experience reflecting expertise in the broad issues that practitioners must address each day in the use of technology -- ethical considerations, mobility, and scope of practice.  A two-day meeting was held in Atlanta in November; the second face-to-face meeting of the TF.  Prior to this meeting the members were grouped into four teams to summarize and outline the various issues identified during its July, 2011 meeting.  Team members reviewed at least 14 content areas that will provide a foundation for telepsychology guidelines (i.e., informed consent, access to care, inter-jurisdictional practice, competence, education, etc.) and produced documents and draft statements which were reviewed electronically.  Conference calls and e-mail discussions facilitated their work between July and November.

            In November, the TF members discussed the work done by the various teams, as well as reviewed the current research and policy literature related to international, national, and state statutes and regulations; as well as guidelines on the use of technology in the delivery of psychological services.  In addition they reviewed the current guidelines related to the delivery of psychological services.  Considerable time was also spent gaining an understanding of the APA process for developing practice guidelines.  Various models for inter-jurisdictional practice were discussed, noting the importance of the issue to many stakeholders.

            Taking into account comments gathered prior to the meeting, the TF worked on the development of an outline for guidelines to be drafted by the four working teams formed by TF members.  The outline reflects the knowledge gained from the review of the literature and research, current and draft documents outlining the use of technology in the delivery of services; and input and feedback from experts, organizations, and individuals.  As a next step, the TF members outlined the key areas and assigned guideline writing teams to begin the preparation of draft guidelines.  Efforts to reach out to identified individuals and groups with expertise in the various content areas will be made.  A time-line was established with the four writing teams sharing their first drafts with the entire TF early this year.  The next step will be to share the evolving draft during a public comment period in the Spring.  APA will host a special session at the APA convention inOrlando.  The convention presentation will focus upon presenting details of the newest draft, discussing feedback received during the public comment period, and providing a face-to-face interaction with the TF members.  Additional input and comments from the field and public will be broadly sought throughout the year [Deborah Baker].

            HHS Fiscal Year 2012 Budget Request:  The Administration's request notes that there are nearly 50 million people living in rural America who face ongoing challenges in accessing health care.  Rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts.  Rural areas also continue to suffer from a shortage of diverse providers for their health care needs.  The goal for the President's "Improving Rural Health Care Initiative" is to build healthier rural populations and communities through evidence-based practices, with the HRSA Office of Rural Health Policy improving the coordination of rural health activities.  These programs are among the only non-categorical grants within HHS which allows grantees to determine the best way to meet local needs.  The $11.5 million telehealth grant initiative will link rural health providers with specialists in urban areas and strengthening rural health care infrastructure.  Has HPA worked with the Lanai FQCHC or HRSA?

            Retirement Really?  These are indeed exciting times.  Upon learning of my "retirement," John Sexton, former U.S. Navy psychologist and one of the first two graduates of the Department of Defense psychopharmacology training program: "Aloha, Thank you for your continued strong efforts on RxP.  I might stick my toe back into the pool, but I have been enjoying my retirement too much.  After retiring on July 1, my wife, son, and I went to Oahu for a month to join our daughter, as she lived there briefly. Hawaii is paradise.  We returned to San Diego, brought a motor home, and have been travelingNorth America ever since.  Knowing your large amount of energy, retirement may be something not in the cards for you.  I thought I would have some trouble with it, but have found it to be wonderful.  Take care."  We shall see….  Aloha,

 

Pat DeLeon, former APA President – HPA – March, 2012