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This scoping review article explores the application of telepresence (TPr), virtual reality (VR), and augmented reality (AR) to clinical care. A literature search of key words was conducted from January 1990 through May 2019 of the following databases: PubMed/Medline, American Psychological Association PsycNET, Pubmed/Medline, Cochrane, Embase, PsycINFO, Web of Science, Scopus, OTSeeker, ABI/INFORM, computer-mediated communication (CMC), technology-mediated communications, Arts & Humanities Citation Index, Project Muse, ProQuest Research Library Plus, Sociological abstracts, Computers and Applied Sciences Complete and IT Source. It focused on concept areas: (1) TPr related to technologies; (2) virtual, augmented, reality, environment; (3) technology or computer-mediated communication; (4) clinical therapeutic relationship (boundaries, care, communication, connect, engagement, empathy, intimacy, trust); (5) telebehavioral health; (6) psychotherapy via technology; and (7) medicine/health care. Inclusion criteria were concept area 1 in combination with 2–7 and 2 or 3 in combination with any of 4–7. From a total of 5214 potential references, the authors found 512 eligible for full-text review and found 85 papers directly relevant to the concepts. From papers’ references and a review of books and popular literature about TPr, virtual reality (VR), and augmented reality (AR), 13 other sources of information were found. The historical evolution of TPr, VR, and AR shows that definitions, foci of studies (e.g., social neuroscience to business), and applications vary; assessments of TPr also vary widely. Studies discuss VR, AR, and TPr in medicine (e.g., rehabilitation, robotics), experimental psychology (laboratory, field, mixed), and behavioral health. Virtual environment (VE) designs aid the study of interpersonal communication and behavior, using standardized social interaction partners, virtual standardized patients, and/or virtual humans—all contingent on the participants’ experience of presence and the ability to engage. Additional research is needed to standardize experimental and clinical interventions, while maintaining ecological validity. Technology can significantly improve quality of care, access to new treatments and training, if ethical and reimbursement issues are better explored.

Background Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.

BACKGROUND Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. OBJECTIVE This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. METHODS A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. RESULTS Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. CONCLUSIONS Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.

In the ever-changing fields of health care, continuing professional development (CPD) and lifelong learning are essential for patient care, regulatory requirements, personal growth, and job satisfaction. However, no specific systems in approaching CPD have been delineated, and most health professionals are left to their own devices to manage it, on top of all their other professional responsibilities. This article (1) outlines the importance of CPD, (2) describes potential systematic approaches to CPD and potential ways to assess their effectiveness, and (3) reviews resources available to incorporate into a systematic approach.

The use of interprofessional health profession education and training (IPE) has been repeatedly identified as a means for developing greater integration and more effective health care. This paper advocates for greater IPE for telebehavioral health care professionals during graduate school, supervised experience, and independent practice. The authors propose that this can be achieved by using the recently developed interprofessional telebehavioral (TBH) competencies as a framework to organize and provide TBH education and training. Major identified barriers to IPE for TBH include professional centrism, exclusive education and training experiences, and lack of experience and training in interdisciplinary TBH teams. Proposed alternatives to promote IPE TBH include increased collaboration in educational experiences across disciplines, use of inclusive TBH training models and rotations for skills and attitudes, development of IPE TBH teams with an emphasis on competencies, and linking TBH institutional infrastructure across organizations and professions.

During the coronavirus pandemic, many behavioral health professionals providing psychotherapeutic services, including couple/marriage and family therapists (C/MFTs), quickly changed from providing in-person services to telebehavioral health (TBH) services, with specific reliance on teleconferencing. Many therapists were thrust into telehealth with minimal or no prior telebehavioral health experience, education, or training. Although TBH services have been shown to be effective and efficient with mental health and substance abuse problems, the teaching and learning of telebehavioral competencies have generally not been included in the formal education and training received by C/MFTs. This article presents an existing interprofessional telebehavioral health competencies framework not before published in C/MFT journals. This article will also demonstrate how those competencies are applicable to the education, training, and practice of telebehavioral health by C/MFTs. Implications for educational, service, and regulatory organizations are presented.

Telebehavioral health (TBH) in the form of synchronous video is effective, well received and a standard way to practice. Current guidelines and policies discuss the importance of good clinical, technical, and administrative components to care. A review of the TBH evidence-based literature across psychiatry/medicine, psychology, social work, counseling, marriage/family, behavioral analysis, and other behavioral sciences found no common TBH competencies across disciplines. The scope of professional guidelines and standards about technology are broad (e.g., practice of telepsychology; Internet and social media use in social work practice), to mid-range (e.g., American Telemedicine (ATA), American Counseling Association (ACA)), to narrow (e.g., preliminary “guidelines” for asynchronous communication such as e-mail and texts). There is only one set of competencies for telepsychiatry, which discusses skills, training and evaluation. These competencies suggested (1) novice/advanced beginner, competent/proficient, and expert levels; (2) domains of patient care, communications, system-based practice, professionalism, practice-based improvement, knowledge and technological know-how; and (3) pedagogical methods to teach and evaluate skills. Revisions to this framework and technology-specific competencies with additional domains may be needed. A challenge to competencies across disciplines may be finding consensus, due to varying scopes of practice, training differences and faculty development priorities. Disciplines and organizations involved with TBH need to consider certification/accreditation and ensure quality care.

The Coalition for Technology in Behavioral Science (CTiBS) has developed an interprofessional, evidence-based, measurable framework for telebehavioral health (TBH) competencies. The paper presents the development of the CTiBS TBH framework, identifies the theoretical rationale and need for such competencies, outlines methods used, provides two detailed discussions of applications, presents a tabulized form of the framework, and then discusses limitations and future research. In the CTiBS TBH competency framework, the term telebehavioral health is meant to include telemental health and e-therapy. The TBH competency framework is offered as an initial working document to identify and organize discreet, measurable telebehavioral practices derived from a review of the literature, technological advances, and day-to-day clinical practice. It reflects core knowledge, skills, and attitudes needed for competent telebehavioral health practice. The competency framework is directly applicable to psychiatry/medicine, psychology, social work, counseling, marriage/family, behavior analysis, and other behavioral sciences. The CTiBS TBH framework organizes seven topic domains and five subdomains according to competency level, i.e., Novice, Proficient, or Authority. In turn, each competency level is categorized into 51 discrete telebehavioral objectives, which are then distinguished by 149 cumulative and measurable telebehavioral practices. The seven TBH competency domains identified by CTiBS include (1) Clinical Evaluation and Care, with three subdomains addressing Assessment and Treatment, Cultural Competence and Diversity, and Documentation and Administrative Procedures; (2) Virtual Environment and Telepresence; (3) Technology; (4) Legal and Regulatory Issues; (5) Evidence-Based and Ethical Practice, with two subdomains addressing Standards and Guidelines and Social Media; (6) Mobile Health and Apps; and (7) Telepractice Development.

The inadequacy of infrastructure for bringing mobile healthcare apps from developers to clinical practitioners has kept the 165,000+ currently available healthcare apps from integration into routine clinical practice. The absence of regulatory and certification processes and the unlikelihood that many apps will be tested with credible clinical trials leaves it up to expert reviews to lead clinicians to high-quality apps. However, most app reviews are not collected in an easily searchable location that facilitates comparison of the merits of alternative apps, and surveys of existing expert reviews reveal a lack of standards for objective and reliable assessments. Furthermore, most published recommendations for apps are not based on their validity or appropriateness for clinical use.This article describes development of the Interactive Mobile App Review Toolkit (IMART), a technology-assisted system for producing verifiable app reviews intended for clinicians and its accompanying evidence-based thesaurus of standards. IMART will present systematized reviews in a searchable, curated library where clinicians can find and compare reviews about apps that are tagged as to the treatment needs of clients/patients and that address how the apps could be integrated into the visitor’s clinical practice.The assessment criteria in the “Digital Health Standards Thesaurus” can be used in reviewing apps and other digital health products, in developing apps, in making decisions about investing venture capital or foundation funds into concepts for new digital health products, and in selecting such products into the “formularies” of third party payers.

Interprofessional telebehavioral health (TBH) competencies have been developed to standardize training and improve the quality of TBH care. The seven identified interprofessional TBH competency domains and three levels of expertise (novice, proficient, and authority) are briefly described. More in depth descriptions and examples of several of the competency domains are presented to illustrate what the competencies look like in practice. Some of the challenges faced in using such a competency framework are discussed.

Table of Contents PREAMBLE SCOPE INTRODUCTION Internet-Based Telemental Health Models of Care Today CLINICAL GUIDELINES A. Professional and Patient Identity and Location 1. Provider and Patient Identity Verification 2. Provider and Patient Location Documentation 3. Contact Information Verification for Professional and Patient 4. Verification of Expectations Regarding Contact Between Sessions B. Patient Appropriateness for Videoconferencing-Based Telemental Health 1. Appropriateness of Videoconferencing in Settings Where Professional Staff Are Not Immediately Available C. Informed Consent D. Physical Environment E. Communication and Collaboration with the Patient's Treatment Team F. Emergency Management 1. Education and Training 2. Jurisdictional Mental Health Involuntary Hospitalization Laws 3. Patient Safety When Providing Services in a Setting with Immediately Available Professionals 4. Patient Safety When Providing Services in a Setting Without Immediately Available Professional Staff 5. Patient Support Person and Uncooperative Patients 6. Transportation 7. Local Emergency Personnel G. Medical Issues H. Referral Resources I .Community and Cultural Competency TECHNICAL GUIDELINES A. Videoconferencing Applications B. Device Characteristics C. Connectivity D. Privacy ADMINISTRATIVE GUIDELINES A. Qualification and Training of Professionals B. Documentation and Record Keeping C. Payment and Billing REFERENCES.

This chapter/article identifies and discusses the urgent need for ongoing telemental health training (TMHTr) for mental health trainees and professionals across several relevant disciplines. A brief historical introduction compares technologies used in the past to educate and train mental health professionals with current ones, noting both the sea change that has occurred just in the past few decades and anticipating equally impressive advances yet to come.

Technology is changing the nature of problems people are having as well as how we treat them. This article discusses how factors associated with use of the Internet may initiate and maintain sexually compulsive behavior online. Ways to make use of web resources in the treatment of online sexual addiction and compulsivity are suggested. Behavioral Telehealth, a possible avenue for conducting psychotherapy using communications technology, is introduced. Ethical, legal, and regulatory issues relevant to using communications technology to practice psychotherapy are reviewed.

Persons with severe functional disabilities are the highest users of health care services. Caring for the needs of this population represents a significant percentage of our national health care costs. A growing body of research has demonstrated the efficacy of self-management strategies and caregiver engagement for effective long-term care for individuals with chronic medical conditions. Economic forces over the past decade have led to new challenges and resulted in major changes in health care delivery resulting in shortened length of inpatient stays and greater limits on the length of outpatient treatment. Telehealth is an innovative method for health care delivery and a means of meeting this new challenge. This paper highlights the findings of three pilot studies on the use of telecommunications technologies in promoting self-care management and enhancing health care outcomes in persons with severe disabilities and their family caregivers. The importance of matching technology to the needs of this population, lessons learned from these investigations, and future directions for research are addressed.

The Internet is proving to be an emerging and promising area of practice for psychotherapists. Known as behavioral e-health, service delivery through the Internet is still in its infancy, however. Guidance for structuring these interactions can be found in the traditional telehealth research literature, where it has been shown that upholding the traditions and requirements of professional practice can be possible while using telecommunication technologies.Therefore, this article offers a telehealth-based model for behavioral e-health service delivery.

A large study (N = 7,037) was conducted through the MSNBC website during June 2000 to explore the general profile of people who engage in online sexual activity (OSA) as well as gender differences in OSA. The study explored ways in which the Internet is used for sexual activities, reasons for engaging in OSA, and consequences of use. The study found a relationship between use of OSA and its consequences in users' lives as well as significant gender differences in user profiles. Significant gender differences were found in reasons respondents gave for engaging in OSA and OSA-related behaviors. Overall, these findings increase our understanding of the user profiles of people who engage in OSA and corroborate gender differences in offline research. Implications for further research are discussed.

Worksite competitions have shown promise in facilitating smoking cessation among employees, but the effectiveness of the competition component itself has not been determined. A multicomponent behavioral treatment and maintenance program plus nicotine gum were provided to competition and no-competition conditions at two large worksites. At 1-year follow-up, 100% of subjects were contacted and measurement of expired carbon monoxide validated abstinence. Recruitment rates were significantly higher in the competition group (2% of smokers) than the no-competition group (0.6% of smokers, P less than 0.001). One-year abstinence rates were 50% for the competition group and 25% for the no-competition group. This difference was not statistically significant (P less than 0.25). However, survival analysis revealed a significant difference in number of weeks abstinent during the year after treatment. Mean weeks abstinent was 35 for competition and 22 for no-competition (P less than 0.05). At the 3-month follow-up, the number of boxes of nicotine gum used predicted abstinence (P less than 0.002). At the 1-year follow-up, rated supportiveness of one's "buddy" (P less than 0.01) and number of sick days prior to starting the program predicted abstinence (P less than 0.003). It is suggested that competition, nicotine gum, and social support may enhance worksite smoking cessation program rates.