Peter Yellowlees
University of California, Davis, Psychiatry & Behav Sci, Faculty Member
- Professor Peter Yellowlees MD works at UC Davis as a clinician, scientist and educator. He has published 0ver 200 pee... moreProfessor Peter Yellowlees MD works at UC Davis as a clinician, scientist and educator. He has published 0ver 200 peer reviewed articles and book chapters, six books and about 180 video editorials on Medscape and regularly presents his work on telemedicine and physician wellbeing at conferences and in the media.edit
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Research Interests: Health Sciences, Biomedical Engineering, Primary Health Care, Global Health, Evidence, and 15 moreMedicine, Library and Information Studies, Humans, Chronic Disease, Mobile Applications, Psychological Intervention, Public health systems and services research, Sex Factors, Cost Benefit Analysis, Age Factors, Intensive Care Medicine, Patient Centered Care, Disease Management, Internet, and Health Services Accessibility
ABSTRACT This article provides an overview of how trainees, faculty, and institutions use technology for acquiring knowledge, skills, and attitudes for practicing modern medicine. The authors reviewed the literature on medical education,... more
ABSTRACT This article provides an overview of how trainees, faculty, and institutions use technology for acquiring knowledge, skills, and attitudes for practicing modern medicine. The authors reviewed the literature on medical education, technology, and change, and identify the key themes and make recommendations for implementing technology in medical education. Administrators and faculty should initially assess their own competencies with technology and then develop a variety of teaching methods that use technology to improve their curricula. Programs should decrease the general knowledge-based content of curricula and increase the use of technology for learning skills. For programs to be successful, they must address faculty development, change management, and funding. Willingness for change, collaboration, and leadership at all levels are essential factors for successfully implementing technology.
Research Interests: Information Science, Educational Technology, Informatics, Higher Education, Health Informatics, and 15 moreFaculty Development, Forecasting, Computer Literacy, Change Management, Learning, Curriculum, Continuing Medical Education, Computers, Faculty, Humans, Advisory Committees, Academic Psychiatry, Curriculum and Pedagogy, Academic, and Automatic data processing
To describe the technical development of an asynchronous telepsychiatry application, the Psychiatric Video Archiving and Communication System. A client-server application was developed in Visual Basic.Net with Microsoft(®) SQL database as... more
To describe the technical development of an asynchronous telepsychiatry application, the Psychiatric Video Archiving and Communication System. A client-server application was developed in Visual Basic.Net with Microsoft(®) SQL database as the backend. It includes the capability of storing video-recorded psychiatric interviews and manages the workflow of the system with automated messaging. Psychiatric Video Archiving and Communication System has been used to conduct the first ever series of asynchronous telepsychiatry consultations worldwide. A review of the software application and the process as part of this project has led to a number of improvements that are being implemented in the next version, which is being written in Java. This is the first description of the use of video recorded data in an asynchronous telemedicine application. Primary care providers and consulting psychiatrists have found it easy to work with and a valuable resource to increase the availability of psychiatric consultation in remote rural locations.
Research Interests: Computer Science, Technology, Biomedical Engineering, Information Management, Workflow, and 14 moreTelemedicine, Medicine, Software, Library and Information Studies, Humans, Videoconferencing, Asynchronous Communication, Mental Disorders, Public health systems and services research, Pilot Projects, Telepsychiatry, Internet, Video Recording, and Referral and consultation
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Research Interests: Pediatrics, Psychiatry, Mental Health, Adolescent, Telemedicine, and 14 moreMedicine, Humans, Child, Child Psychiatry, Mental health services, Confidentiality, Adolescent Psychiatry, Rural Health Services, Telepsychiatry, Child Health Services, Child preschool, parental consent, Paediatrics and reproductive medicine, and Physician-Patient Relations
Research Interests: Psychiatry, Technology, Biomedical Engineering, Primary Health Care, Cultural Competency, and 15 moreTelemedicine, Medicine, Library and Information Studies, Humans, Female, Male, Mental Disorders, Medical Diagnosis, Middle Aged, Observer Variation, Adult, Public health systems and services research, Kappa, Socioeconomic Factors, and Psychiatric Status Rating Scales
Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the... more
Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the development of a training model for ATP clinician skills.Methods: Clinical and procedural training for ATP clinicians (n = 5) was provided by master's-level, clinical mental health providers developed by three experienced telepsychiatrists (P.Y. D.H., and J.S) and supervised by a tele-psychiatrist (PY, GX, DL) through seminar, case supervision, and case discussions. A training manual and one-on-one sessions were employed for initial training. Unstructured expert discussion and feedback sessions were conducted in the training phase of the study in year 1 and annually thereafter over the remaining 4 years of the study. The notes gathered during those sessions were synthesized into themes to gain a summary of the study telepsychiatrist training recommendations for ATP interviewers.Results: Expert feedback and discussion revealed three overarching themes of recommended skill sets for ATP interviewers: (1) comprehensive skills in brief psychiatric interviewing, (2) adequate knowledge base of behavioral health conditions and therapeutic techniques, and (3) clinical documentation, integrated care/consultation practices, and e-competency skill sets. The model of training and skill requirements from expert feedback sessions included these three skill sets. Technology training recommendations were also identified and included: (1) awareness of privacy/confidentiality for electronic data gathering, storage, management, and sharing; (2) technology troubleshooting; and (3) video filming/retrieval.Conclusions: We describe and provide a suggested training model for the use of ATP integrated behavioral health. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians, and more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed. Clinical Trials number: {"type":"clinical-trial","attrs":{"text":"NCT03538860","term_id":"NCT03538860"}}NCT03538860.
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The traditional face-to-face doctor-patient relationship is the core of conventional medical practice. One key aspect of this changing relationship is the increasing dependency on asynchronous data collection in clinical consultations.... more
The traditional face-to-face doctor-patient relationship is the core of conventional medical practice. One key aspect of this changing relationship is the increasing dependency on asynchronous data collection in clinical consultations. Such electronic communications and data streams may be numeric, text-based, audio, digitized still pictures, video and radiologic, as well as emanating from multiple medical devices. While asynchronous medicine may be established in specialties like radiology and dermatology, there is little research regarding the use of asynchronous medicine in areas of medicine that traditionally rely on the physical doctor-patient interaction such as primary care, internal medicine, geriatrics, and psychiatry. The practice of psychiatry stands out as a discipline that is highly dependent on the quality of the physical meeting between the doctor and the patient, yet even in this specialty it is possible to utilize asynchronous medicine for some types of psychiatric consultations. Asynchronous medicine has the potential to be significantly disruptive to our current healthcare processes, as well as more clinically and economically efficient.
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BACKGROUND Telehealth, mobile health 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... more
BACKGROUND Telehealth, mobile health 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 addresses the overarching question: “What is technology-based fatigue and what are its consequences for providers?” METHODS A six-stage scoping review of 12 literature databases, from years 2000-20, focused on technology, health care and fatigue. Technologies were inclusive of synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care, in four concept areas related to provider experience: 1) behavioral, cognitive, emotional and physical impact; 2) workplace at the individual, clinic, hospital and system/organizational levels; 3) well-being, burnout and stress; and 4) perceptions regarding technology. RESULTS Out of 4,221 potential literature refe...
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Asynchronous technologies like mobile health, e-mail, e-consult, and asynchronous video telepsychiatry are effective modes of service delivery to a variety of settings and populations. To ensure quality care, clinicians need skills,... more
Asynchronous technologies like mobile health, e-mail, e-consult, and asynchronous video telepsychiatry are effective modes of service delivery to a variety of settings and populations. To ensure quality care, clinicians need skills, knowledge, and attitudes for these technologies. This scoping review was based on the research question, “What skills are needed for clinicians and trainees to provide quality care asynchronously have been published, and how can they be made measurable and reproducible to teach and assess them?” A key word search was done in 9 databases based on five concept areas: (1) competencies; (2) asynchronous technologies; (3) synchronous video; (4) clinical therapeutic relationship; and (5) consultation to primary care. From a total of 4812 potential references, two authors found a total of 86 papers based on inclusion and exclusion criteria. Clinical studies rarely discuss specific skillsets or competencies. Existing publications on video, social media, and mobile health were used to build an asynchronous technology competency set according to the Accreditation Council of Graduate Medical Education framework. Training, faculty development, and administrative changes to service delivery and workplace culture are suggested as part of institutional competencies. Research is needed on how to implement and evaluate asynchronous competencies for clinical care and training as part of organizational change to build a positive e-culture. Research is also needed across cultures and across user’s health, lifestyle, and clinical care experiences.
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BACKGROUND Asynchronous Telepsychiatry (ATP) consultations (delayed time) can extend psychiatric expertise into primary care, and across languages. OBJECTIVE This is the first clinical outcomes study of ATP compared with Synchronous (real... more
BACKGROUND Asynchronous Telepsychiatry (ATP) consultations (delayed time) can extend psychiatric expertise into primary care, and across languages. OBJECTIVE This is the first clinical outcomes study of ATP compared with Synchronous (real time) Telepsychiatry (STP), the current gold standard telepsychiatry “usual care” method. We hypothesized that patients in the ATP arm would show a better clinical trajectory than those in the STP arm as measured by clinician and patient self-reported ratings of depression, global functioning and health outcomes. METHODS In this randomized clinical trial 36 Primary Care Physicians (PCP) referred a heterogeneous sample of 401 treatment seeking adult depressed or anxious patients over a 5- year period from 3 primary care clinics. 184 English and Spanish speaking participants were enrolled and randomized, of whom 160 (80 ATP, 80 STP) completed baseline evaluations and were entered into the 2-year follow up study. Patients were treated by their PCPs in...
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Objective: To compare clinical recommendations given by psychiatrists and the adherence to these recommendations by primary care physicians (PCP) following consultations conducted by asynchronous telepsychiatry (ATP) and synchronous... more
Objective: To compare clinical recommendations given by psychiatrists and the adherence to these recommendations by primary care physicians (PCP) following consultations conducted by asynchronous telepsychiatry (ATP) and synchronous telepsychiatry (STP). Materials and Methods: ATP and STP consultations were compared using intermediate data from a randomized clinical trial with adult participant enrollment between April 2014 and December 2017. In both study arms, PCPs received written recommendations from the psychiatrist after each encounter. Independent clinicians reviewed PCP documentation to measure adherence to those recommendations in the 6 months following the baseline consultation. Results: Medical records were reviewed for 645 psychiatrists' consult recommendations; 344 from 61 ATP consultations and 301 from 62 STP consultations. Of those recommendations, 191 (56%) and 173 (58%) were rated fully adherent by two independent raters for ATP and STP, respectively. In a multilevel ordinal logistic regression model adjusted for recommendation type and recommended implementation timing, there was no statistically significant difference in adherence to recommendations for ATP compared with STP (adjusted odds ratio = 0.91, 95% confidence interval = 0.51-1.62). The profiles of recommendation type were comparable between ATP and STP. Conclusions: This is the first PCP adherence study comparing two forms of telemedicine. Although we did not find evidence of a difference between ATP and STP; this study supports the feasibility and acceptability of ATP and STP for the provision of collaborative psychiatric care. Clinical Trial Identifier NCT02084979.
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Purpose of Review The evidence for the impact of climate change on the mental health of individuals and communities is reviewed, and the literature on the importance of digital systems in reducing carbon emissions is addressed. Recent... more
Purpose of Review The evidence for the impact of climate change on the mental health of individuals and communities is reviewed, and the literature on the importance of digital systems in reducing carbon emissions is addressed. Recent Findings Most of the climate change impacts on mental health are disaster related, although recent literature on “eco-anxiety,” often described as anxiety about the long-term effects of climate change, is emerging. There is strong evidence that the use of telepsychiatry and digital approaches to mental health care can reduce carbon emissions by reducing travel for patients and providers as well as provide effective distance care in disasters. Hybrid care, asynchronous consultations, and care at home are all innovations that will further reduce carbon emissions. Summary The COVID-19 pandemic has rapidly accelerated the digitization of psychiatry, and climate change will continue to drive these changes in the future. Much more research on these overlappi...
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Executive Summary This document reflects the strongly held views and perspective of a diverse group of healthcare academicians, researchers, providers, and industry representatives from across the country who share a belief in the... more
Executive Summary This document reflects the strongly held views and perspective of a diverse group of healthcare academicians, researchers, providers, and industry representatives from across the country who share a belief in the necessity of healthcare reform and the centrality of telemedicine— or information technology–enhanced healthcare—in that reform. The need for reform stems from long-standing problems in our health system, and the central role of telemedicine derives from an ever-expanding body of research and experience that attests to its merit in addressing these problems. Despite the fact that the
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Background During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter... more
Background During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. Methods We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. Results Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restr...
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There is little published evidence on how well family medicine physicians (FMPs) with substance use disorder (SUD) perform in Physician Health Programs (PHPs). We examined outcomes for FMP compared with non-FMP physicians. This study... more
There is little published evidence on how well family medicine physicians (FMPs) with substance use disorder (SUD) perform in Physician Health Programs (PHPs). We examined outcomes for FMP compared with non-FMP physicians. This study utilized data from a 5-year, longitudinal, cohort study involving 904 physicians with diagnoses of SUD consecutively admitted to one of 16 state PHPs between 1995 and 2001. We compared 175 FMPs to 687 other physicians. Outcome measures were relapse, successful completion of monitoring contract at 5 years, and licensed and employed at 5 years. Of the 3 outcome variables measured: relapse, successful completion of monitoring contract at 5 years, and licensed and employed at 5 years, FMPs had similar rates of success on all variables except monitoring contract completion at 5 years when compared with the other physician cohort. In this study, FMPs with SUD do as well as other physicians in PHPs at 5 years. However, FMPs were less likely to complete the mon...
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Background Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP)... more
Background Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. Objective This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. Methods Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health tele...
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This paper describes the main concept depicted in a recent grant proposal submitted by UCDavis to the National Institute of Health NIH January 31, 2006 to improve the education and training of the School of Medicine researchers at... more
This paper describes the main concept depicted in a recent grant proposal submitted by UCDavis to the National Institute of Health NIH January 31, 2006 to improve the education and training of the School of Medicine researchers at UCDavis. The proposal posits that a managed learning (informatics-rich) environment MLE will enhance the education and continuous training of researchers by allowing them access to rich learning research resources through specialized software and databases not normally accessible to researchers while formulating ideas and theories, solving problems, and analyzing data. The paper describes the proposed portal and more importantly, the evaluation component which will drive the continuous re-design of the system
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Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the... more
Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the development of a training model for ATP clinician skills. Methods: Clinical and procedural training for ATP clinicians (n = 5) was provided by master's-level, clinical mental health providers developed by three experienced telepsychiatrists (P.Y. D.H., and J.S) and supervised by a tele-psychiatrist (PY, GX, DL) through seminar, case supervision, and case discussions. A training manual and one-on-one sessions were employed for initial training. Unstructured expert discussion and feedback sessions were conducted in the training phase of the study in year 1 and annually thereafter over the remaining 4 years of the study. The notes gathered during those sessions were synthesized into themes to gain a summary of the study telepsychiatrist training recommendations for ATP interviewers. Results: Expert feedback and discussion revealed three overarching themes of recommended skill sets for ATP interviewers: (1) comprehensive skills in brief psychiatric interviewing, (2) adequate knowledge base of behavioral health conditions and therapeutic techniques, and (3) clinical documentation, integrated care/consultation practices, and e-competency skill sets. The model of training and skill requirements from expert feedback sessions included these three skill sets. Technology training recommendations were also identified and included: (1) awareness of privacy/confidentiality for electronic data gathering, storage, management, and sharing; (2) technology troubleshooting; and (3) video filming/retrieval. Conclusions: We describe and provide a suggested training model for the use of ATP integrated behavioral health. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians, and more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed. Clinical Trials number: NCT03538860.
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The World Wide Web is becoming a new medium of medical practice.
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Control Group 621 (28%) 986 (44%) 645 (22%) 2252 pyogenic infections of the skin and lower respiratory tract beginning in infancy. Many patients with eczema develop high IgE levels and often suffer from superficial to deep skin abscesses.... more
Control Group 621 (28%) 986 (44%) 645 (22%) 2252 pyogenic infections of the skin and lower respiratory tract beginning in infancy. Many patients with eczema develop high IgE levels and often suffer from superficial to deep skin abscesses. Whether or not hyper IgE syndrome represents just one end of the spectrum of what one sees with chronic atopic eczema or whether it is a separate condition has always been an area of some controversy. I quote a number of the salient features of the hyperIgE (Job's) syndrome from a review written by Buckley and Sampson in 1981.' All their patients had staphylococcal furunculosis. All had staphylococcal pneumonia and 20 of 21 had pneumatoceles. Most had also had infections of joints, viscera and blood. I do not believe the series reported in this letter truly match this clinical background. The rash is typically a pruritic dermatitis, not typical of atopic eczema, and there is little or no history of respiratory allergy. There is often a family history, suggesting that the genetic pattern may be autosomal dominant. I believe that the 50 patients described in this letter are much more likely to represent atopic eczema with secondary staphylococcal skin infection. Paul Gatenby, FRACP Acting Head, Department of Immunology Royal Prince Alfred Hospital. Camperdown, NSW 2050 1. Buckley RH. Sampson HA. The hyperimmunoglobulinemia E syndrome. In: Franklin EC. ed. Clinical immunology update 1981. Edinburgh: Churchill Livingstone. 1981: 147-167.
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Health care will undoubtedly change over the next 20 or 30 years as eHealth technologies become increasingly used and accepted (Treister, 1997; Yellowlees, 1997, 2001). At a global level, the health care system is moving away from... more
Health care will undoubtedly change over the next 20 or 30 years as eHealth technologies become increasingly used and accepted (Treister, 1997; Yellowlees, 1997, 2001). At a global level, the health care system is moving away from episodic care to concentrating on continuity of care, especially for patients with chronic diseases (Yack, 2000), who will give rise to the greatest disease burden in the future (Murray & Lopez, 1999). Many countries are gradually moving away from a focus on the service provider to a focus on the informed patient, and from an individual approach to treatment to a team approach. Increasingly there is a concern less with the treatment of illness and more with the need for wellness promotion and illness prevention, which, of course, parallels a shift away from traditional care to community care.
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Telemedicine is a technology of the future, available today. Here, we describe successful telemedicine systems used across Australia and review barriers to further implementation. Greater academic and multidisciplinary involvement, as... more
Telemedicine is a technology of the future, available today. Here, we describe successful telemedicine systems used across Australia and review barriers to further implementation. Greater academic and multidisciplinary involvement, as well as adequate funding, is needed for the further development and evaluation of these systems.
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Psychiatric assessments must often be performed in the community, which may mean in the community health clinic or general practice surgery, the local supermarket, bank, motel or the patient's own home. A large number of assessments... more
Psychiatric assessments must often be performed in the community, which may mean in the community health clinic or general practice surgery, the local supermarket, bank, motel or the patient's own home. A large number of assessments are done by telephone, particularly in rural areas where patients are unable to get in to see their general practitioner, or through the Royal Flying Doctor Service. Emergency assessments may take place in a police station, hospital emergency department, boarding house, hostel, or at the doctor's own home when someone turns up inappropriately or unannounced. More dramatic assessments may be done in sieges or after major traumas such as motor vehicle accidents, homicides or suicides. A process for emergency assessments is described in Box 1. Little has been written about the "real world" of psychiatric assessment in community practice, with no references on this topic appearing on Medline or Psychlit from 1983 to 1996. Major psychiatric textbooks':" give detailed descriptions of how to examine the mental state of patients, as do textbooks on general practice.' Such an assessment is all that one can make when seeing a patient in a controlled office or clinic setting, and the descriptions in the literature of how to do mental state examinations are generally written from that perspective. This article concentrates on psychiatric assessments as made by general practitioners and uses the mental state assessment as only one of a range of data-gathering exercises that are often required in community settings. One important issue in community practice is the focus of the psychiatric presentation, because this is what gives the assessment its purpose. It is crucial to be pragmatic and to clarify what are the patient's major concerns before addressing any of one's own. This frequently means that considerable time is spent on issues such as finance, food, housing and carers' needs, which often need instant action." In community settings exploration of psychopathology and symptomatic treatment strategies is often of less immediate importance and can usually be more easily addressed later, once the trust of the patient has been engaged. In emergency situations, assessments may often be fairly brief, especially if a situation is out of control. Such assessments should generally be aimed at answering the simple