To Skype or Not to Skype, That is
the Question
Judi Platt RN, CARN
Jordanna Graves MSW, RSW
Physician Health Program
Toronto, Ontario
Canada
Who we are...
• Since 1995 the Physician Health Program of the Ontario
Medical Association has provided monitoring, advocacy,
and clinical referral services to physicians in Ontario.
• Over the years the program has expanded to include all
Substance Use Disorders, Axis 1 Disorders as well as our
newest program, the Physician Workplace Support
Program (PWSP).
• Our services are also extended to students, residents,
veterinarians and pharmacists.
Dedicated to Doctors. Committed to Patients.
PHP Monitoring Program:
• All monitoring programs include:
» Case Manager
» Primary Monitor
» Treating Clinician(s)
» Family Physician
» Workplace Monitor(s)
» Family Member
Depending on the type of contract it may also include:
» Therapist
» Caduceus Group Facilitator
» Self Help Groups and Sponsor
» After Care Facilitator
» Mentor
» Biological Monitoring
Dedicated to Doctors. Committed to Patients.
Dedicated to Doctors. Committed to Patients.
Primary Monitor Interviews
• An instrument used to gather information and build relationships with
our participants.
Questions reflect:
Status/stability of participant’s wellness, recovery program
Attitudes, including acceptance, insight, progress
Maintenance program i.e. aftercare, support groups,
sponsorship
Clinical Resources
Relationships with others and self
Self Care incl. exercise, nutrition, sleep, hobbies
Spirituality
Readiness to return to work/ability to manage work/school,
work hours
Ability to manage life stressors
Dedicated to Doctors. Committed to Patients.
Dedicated to Doctors. Committed to Patients.
An important component of the primary
monitor interview is the relationship between
the participant and the primary monitor.
Dedicated to Doctors. Committed to Patients.
Why Videoconferencing?
• Growing program and case loads.
• Creating more efficient practices.
• Increasing demand for services far away from Toronto.
• Cost and time of travel for both participant and primary monitor.
• No local/regional primary monitor available.
• For clinical reasons, the case manager may be the “best fit” as the
primary monitor even with the distance.
• Phone interviews do not provide a “full picture” i.e. Non verbal
presentation and cues, and it can be difficult to build a relationship.
Dedicated to Doctors. Committed to Patients.
Project Development
• Literature search
Quote from literature search:
“The results provide support for the reliability of structured
interviews administered via teleconferencing, suggesting
that providers can expect remote interviews to provide
clinical information similar to that obtained by interviews in
person” Lexen, Hawk, Herrick & Blank, 2006
Dedicated to Doctors. Committed to Patients.
Project Development continued:
• A six month time line was decided for this pilot.
• Comparison of the different types of Videoconferencing
technology which resulted in the selection of using Skype
for this pilot project.
Dedicated to Doctors. Committed to Patients.
Project Development continued:
• Consent forms:
1. “Acknowledgement to Release of Liability.” This consent form
described the utilization of Skype in the videoconferencing project as
well as acknowledgement of the loan of the video camera from the
PHP.

Skype is not entirely a secure technology.

Skype offers an encryption for direct communication between users,
however, a Skype spokesperson refused to deny the possibility that
communication could be intercepted.
2.
Criteria Agreement
Dedicated to Doctors. Committed to Patients.
Project Development continued:
Criteria for Involvement in the Pilot Project:
1. The participant may have any psychiatric and/or substance use diagnosis as
long as he or she is considered stable by the PHP.
2. The participant’s contract must be at least two years in length.
3. The participant must be willing to participate in primary monitoring interviews
every one to two months.
4. The participant can live in any location across Ontario .
5. The primary monitor and case manager must be the same person.
6. The participant must have had previous experience with both in person and
telephone primary monitor interviews.
Dedicated to Doctors. Committed to Patients.
Criteria for Involvement in Pilot Project cont.:
7. The participant must be entirely willing to participate and commit to the six month
duration of the pilot project.
8. The participant must be willing to complete the evaluation form after each
videoconferencing interview and the final evaluation form at the end of the pilot.
9. The participant must be willing to sign the “Acknowledgement to Release of
Liability.”
10. The participant must have access to a computer with high speed internet.
11. The participant agrees to pay for their internet access.
12. If the participant experiences a period of instability and/or if a situation were to
arise where the PHP believes it is more appropriate to meet in person during the
pilot project, the participant must agree.
Dedicated to Doctors. Committed to Patients.
Project Development continued:
• Evaluation process developed for both participants and
primary monitors:
An evaluation form was completed by both the participant and the
primary monitors after each Skype primary monitoring interview.
Each participant and primary monitor also completed a final
evaluation which provided feedback regarding the overall Skype
experience.
The areas targeted in the evaluation forms were:
1. Technology and Equipment
2. Impact of Technology on Clinical Relationship
3. Confidentiality
4. Cost Effectiveness
5. Overall Satisfaction
Dedicated to Doctors. Committed to Patients.
Project Development continued:
• A Technology Use Guide was developed
Dedicated to Doctors. Committed to Patients.
Implementation
• 4 Case Managers, 2 participants each, for a total of 8
participants in pilot.
• All Case Managers participated in an inservice describing in
detail the pilot project and the evaluation process.
• Participants that met the criteria were randomly chosen.
• Case Managers discussed the project with each chosen
participant and if the participant was agreeable, the participant
signed the consents and was provided a video camera.
• Following each Skype interview, Case Managers submitted both
their participants’ and their own evaluation forms.
Dedicated to Doctors. Committed to Patients.
Other Considerations:
1. Impact on the clinical relationship with the participant
2. Impact on the clinical relationship with the other supports, i.e. spouse/partner, workplace
monitor
3. Cost effectiveness
4. Does the use of this technology exclude certain participants? i.e. High speed internet
5. Accessibility
6. Ease of use
7. In what capacity will videoconferencing play a role at the PHP (replace telephone
interviews, face to face or both?)
8. Will videoconferencing enhance the PHP practices?
9. Participant acceptability
10. Confidentiality
Dedicated to Doctors. Committed to Patients.
Evaluation Results
• A 5-Point scale was used: Very Satisfied,
Satisfied, Neutral, Dissatisfied, Very Dissatisfied
• Overall feedback from all was in the satisfied to
very satisfied range.
• However, there were certain themes and
considerations consistent throughout both the
participant and case manager evaluations.
Dedicated to Doctors. Committed to Patients.
Evaluation Results
Dedicated to Doctors. Committed to Patients.
Evaluation Results continued:
Dedicated to Doctors. Committed to Patients.
Evaluation Results Continued:
Impact of Technology on Clinical Relationship
Dedicated to Doctors. Committed to Patients.
Evaluation Results continued:
Dedicated to Doctors. Committed to Patients.
Evaluation Results continued:
Cost Effectiveness:
Cost saved for participants: $30-$1000. Total of $3650, with an avg. of $213.
Time saved for participants: From 1.5 hours to 48 hours. Total of 191 hours,
with an avg. of 11.2 hours.
Case managers were not asked to estimate their savings in cost or time since
most of these interviews would have been conducted by telephone or the
participant would likely have travelled to the case manager.
The large cost and time savings were very appreciated by the participants.
Dedicated to Doctors. Committed to Patients.
Evaluation Results continued:
Dedicated to Doctors. Committed to Patients.
Evaluation Results continued:
Dedicated to Doctors. Committed to Patients.
Considerations for Results
• Only a small number of participants used in this pilot project.
• Participants really appreciated the time and cost savings, especially the
rural individuals and perhaps were willing to overlook technological
difficulties because of convenience and savings (Especially during the
winter time).
• Plan to continue to explore new technologies in the future.
• There were a few participants who declined to participate in the
videoconferencing pilot project stating that they appreciated meeting in
person.
Dedicated to Doctors. Committed to Patients.
Final Conclusion
• Great overall support from the participants for the continued use of
videoconferencing technology for Primary Monitor interviews.
• Case Managers were satisfied with continued use of videoconferencing
technology as long as certain criteria is initially established.
• It was found that videoconferencing is better than telephone only interviews,
but in person interviews are preferred by both Participants and Case
Managers. Regional monitors preferred.
• It is recommended if utilizing videoconferencing for primary monitor interviews
that in person interviews be conducted at least once per year and once initial
relationship has been established.
Dedicated to Doctors. Committed to Patients.