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GoogleHelpouts by Google is a video platform for worldwide consumers to connect with a wide variety of experts. ​Currently available areas of focus for Helpouts’ experts include arts and video; computers and electronics; cooking; education and careers; fashion and beauty; fitness and nutrition; home and garden, and yes — health care.
In a recent article,​ the​ New York Times described Helpouts as suitable for “retired doctors” and other advice-givers to develop a source of income. Experts can charge by the minute or charge a fixed rate, and keep 80 percent. Helpouts keeps 20 percent of revenue.

Helpout’s First Health Care Service

Helpouts’ medical services are launched with One Medical Group for “colds, flus, allergies, sinus issues, simple infections, UTIs, rashes general advice and consultation.” It is noteworthy that One Medical Group is also careful to mention that the plan’s members have the ability to see providers in 25 office locations across the country. Currently, membership is only available for new patients who live near one of their offices, and can access care locally when needed.

What about Licensure, HIPAA & ​Telemental Health?

Helpouts’ health services are geared to licensed professionals. They also claim HIPAA compliance and include this statement:

Some examples of Helpouts listings that fall under these restrictions include: advisory or informational health services; counseling or therapy services; health consultation services; or other professional health services.

Other statements also make it clear that Helpouts is to be taken seriously. For example, Helpouts’ ​​”health services” will not be recorded,  and therefore not subject to the same review by Google staff as other Helpouts services.  Give an Hour announced on November 5th that it will bring a network of licensed mental health professionals to ​Helpouts.

Google’s Bold New Model will Help Clinicians Escape Health Care Reform Realities

Google then, appears to be inviting ​ licensed ​​clinicians to ​move away from reimbursable healthcare with virtual offices to sell services by-the-minute​ or for a flat fee through the Helpouts’ Health directory.
Google is known for its disruptive technology and in this case, their timing is remarkable. Helpouts’ invitation to private pay (concierge) services might be the escape many clinicians will be seeking to evade the oncoming yoke of health care reform, with its requirements for added accountability, documentation, and capitated care.

Let’s All Jump In, Right?

Nonetheless, Helpouts is worthy of pause.  We researchers, educators, clinicians and policy makers will do well to appreciate the reality of our changing health care environment and the potential of technology to reach many more consumers. As I have been advocating since 1994, professional groups need to realize that technology is not going away and is likely to transform how we conduct our services. Adequate protections need to be in place for consumers.
Although licensed, behavioral and mental health professionals are untrained in telemental health intake, assessment, documentation, informed consent,  patient education or risk management.  They are not equipped to adequately compensate for a lack  enforcement related to state regulation or professional association standards. They haven’t been able to decipher the complicated and often overwhelming publications related to using technology released by some associations. They see opportunity in Helpouts or Skype, but don’t have the time or interest needed to earn their own livings and keep abreast of the rapidly evolving legal, ethical, clinical and technical issues needed to practice responsibly.

Oklahoma Psychiatrist: Dr. Trow

A good case in point is that of the Oklahoma psychiatrist, Dr. Trow, who just recently was disciplined for using Skype; failing to engage the patient in an appropriate informed consent process; failing to have an in-person assessment prior to delivering care via videoconferencing and other infractions.

What’s Missing from Google’s Helpouts?

The missing component in Helpouts is not Google’s technology. Rather, it is awareness on the part of clinicians they best practices need to be followed, regardless of how they communicate with their clients/patients. The concerning reality is that most professionals know the many legal, ethical and clinical risk management issues required by such environments. They often don’t. Most have not undergone even the most minimal of training. What’s missing then, is not Google’s responsibility. Rather, it the professional’s adherence to best practices when offering services by-the-minute, or in small amounts of time that preclude the standard processes inherent to professional care.
In services sold by-the-minute, professionals are unlikely to have time for attending to best practices that include but are not limited to: careful  intake/assessment, informed consent, or establishing required emergency backup  systems. General concerns include:

  1. How can clinicians conduct an appropriate intake or collaborate with other treating professionals when consumers buy minutes for answers to very complicated questions?
  2. How will consumers know which professional is and isn’t qualified to treat various issues, such as cultural, religious, linguistic differences across geographic areas, in addition to differences across disciplines and specialty areas?
  3. Are clinicians who haven’t been trained as telemental health practitioners acceptable for technology-based mental health care delivery?
  4. How will informed consent, assessment, required documentation, and most importantly, emergency backup be handled?
  5. How will consumers be educated about the unseen, unrealized requirements of professionals, such as mandated abuse reporting or Tarasoff interventions?
  6. Will all clinicians follow in the footsteps of One Medical Group and maintain brick-and-mortar offices to provide local services if needed?
  7. When will regulatory boards and professional associations imposing standards and guidelines going respond to licensed professionals who choose Google and/or competitors to sell services by-the-minute?

The problem is that interested professionals don’t know where to turn for timely, accurate information when opportunity knocks, such as with Helpouts.
See also:

The TeleMental Health Institute’s professional training and Certificate program

Why Online Practice Can Be Dangerous — Part I