I'm a big believer that this could be a major part of future practice, if we get over the fear of it. There are already internists and surgeons doing hospital rounds via video link with a PA or trained nurse at bedside. In residency, one of my attendings was doing telepsychiatry with those who cannot physically make it into the office. A case mgr was sent out with the video link equipment, and the doc stayed at the office. Patients were adequately treated and improved dramatically, and as soon as they were more able, there was already a relationship with a Case Mgr to help get them out, socializing, taking a greater role in their own lives.
I think it's an interesting technology that has the potential to increase access to care as well as free up psychiatrists to work from home, travel, whatever. I also think it's more acceptable in an era where such a large proportion of human interactions are occuring online.
It's already widespread within the VA on a small scale, and is going to be getting much more frequent soon--there's a big push by the VA to get psych services to their rural clinics and tele is a part of that. I think it's going to become pretty widespread in the private sector as well, but again mainly as a way to get psychiatric care into the boondocks. There are definite disadvantages to tele (not having someone in the room etc) that would make it kinda silly to use if someone was within driving distance of another psychiatrist.
At my VA hospital there's telepsychiatry to the remote VA clinics associated with us that are a 6-7 hour car ride away, and this is how the psychiatrists in our big city VA see the patients out there--initial eval, followups, everything. they write the meds through the VA computer system. there's a psych nurse on the other end who helps coordinate the video feed, scheduling, etc.