Teleneuropsychology

The growth of telemedicine has been rapid. Initially, telemedicine was seen as a way to bring services to remote areas that lacked access to aspects of health­care delivered through traditional means. This view of telemedicine has changed. Current views toward telemedicine have broadened, with telemedicine now viewed as an effective way to deliver various health services and to bring together patients and providers to increase access to care in various locations and communities. Reimbursement has been a challenge for some aspects of telemedicine development. Initially, Medicare limited reimbursement for telehealth to designated underserved areas. This approach to telehealth reimbursement has lagged behind developments in the field and has been challenged by various groups and legislative initiatives. In April 2016, the Centers for Medicare and Medicaid Services (CMS) released its Managed Care Final Rule (Federal Register, 2016) with wording that potentially will permit reimbursement for expanded telemedicine-based services. The revised standards, in attempting to ensure that Medicaid beneficiaries have reasonable access to care, acknowledge a role for technology and telemedicine. The impact the new standards will have on the development of telemedicine throughout the United States will become evident with time. Tele-mental health has grown along with other aspects of remote healthcare delivery. Extant literature supports the use of remotely delivered telehealth for a variety of conditions and services, including remote psychiatric consultation, diagnosis, and various therapies (Myers & Turvey, 2012; Shore, 2013). However, the idea that one can provide an adequate neuropsychological evaluation remotely is newer and less intuitive, and would appear to have obvious challenges. Neuropsychological examinations frequently require the use of test stimuli that the examinee has to handle and manage, such as blocks, pencils, or other manipulatives. Some tests, such as the Wisconsin Card Sorting Test (Heaton, 2003), have been adapted for computer but not for Internet-based or remote administration. In some approaches to neuropsychological assessment, the examiner takes careful note of the specific strategies examinees employ when attempting to perform tasks. Hence, performing an examination when the examiner and the patient are in different locations can seem daunting.