[Telepsychiatry at the service of autism].

Introduction: The authors report on the set-up of a telehealth system developed to facilitate exchanges between the Autism Resource Centre of Brittany (centre de ressources pour l'autisme [CRA]) located in Brest and an adult psychiatry structure of Vannes' Hospital in the Morbihan region, these sites are about 200 kilometres distant.

Objectives: This coordinated work using computer networks aims at sustaining the action of a unit specialised in autistic patients. The goal is to both render a precise diagnostic (teleexpertise) and favour assistance and support to residents and their families while instituting a medical education tool for the health professionals of this unit.

Methods: The creation of this telehealth experience, using multiple contact video conferencing, was possible thanks to the existence of the Megalis network, a high speed telecommunication system deployed in the Britanny and Loire region. The connexion of the two sites is made through Cisco type routers. Both sites are linked to the network through urban fiber optics (2-40 MMytes/s output) or Integrated Services Digital Network (ISDN) Access (64 or 128 kbytes/s output). This virtual private network (VPN) style high speed link offers a transparent and secure connexion through the service provider (Novasight) which supervises the technical organisation and the management of the address books of the various listed sites, controls access to the network and manages the network speed. As far as appliances are concerned, (video camera, LCD screen, microphone, maintenance, training), the cost is about 11,000 euros. From their experience, the authors develop the following applications: tele-staffs are meetings of about 2hours in length.

Discussion: The authors insist on some essential rules, such as putting on the agenda the items to be discussed at the meeting, handing out to everyone the documents needed for the meeting, and designating someone in charge of guaranteeing the good progress of the meeting. His/her functions are to guarantee a precise format for the meeting, to distribute speaking time fairly, to clearly formulate the decisions made (organisation of results, summing up diagnostic results and evaluation of competencies, common institutional actions, arrangement of projects, university research and trainings, scheduling future meetings). Still using their experiences, the authors put forward several recommendations on technology, video and audio links (framing, sound checks, multidirectional microphones, video quality - forcing people to limit rapid gestures…) but also insist on having fit for purpose rooms (soundproofing, neutral decor, homogenous lighting, neon for example…). Contact with patients and their family through video-conference: despite being used less, this technique has shown its pertinence especially for the evaluation of diagnostics and competencies. In practice, the families are joined by the health professionals in charge of the patient in that institution. A meeting chair must be nominated, in our case the doctor in charge of the unit for autistic persons. The doctor from the CRA sits in on the meeting as consulting expert and intervenes at the invitation of the chair. The plan for the meeting and the must-ask questions have to be determined beforehand by the two doctors, so as make sure the meeting will be fast flowing and all the relevant clinical and biographical data are collated. Families, seeing different institutions working together to help their family member despite the distances using high tech solutions, were very satisfied.

Conclusion: On the whole, the authors help us to have good insight into the obstacles (cultural, administrative, technological) and the benefits (availability of consultants with specific competencies, reduction in the waiting time, more efficient use of resources, reduction in costs and risks of travel and of CO(2) emissions…). They believe that health professionals cannot and should not completely avoid travel to the other sites because it is important to get to know the teams well, which is a prerequisite to a good video-conference meeting. This helps creating new directions for the future.