TrendS and OPPORTUNITIES TECHNOLOGY IN PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL The costs, ethics and legal aspects TESTING of online and telehealth evaluations BY STACEY LARSON, JD, PsyD GOOD PRACTICE WINTER 2019 13 TrendS and OPPORTUNITIES dvancements in technology have made long-distance mental health care a reality. New software for laptops and tablets now allows provid- ers to perform psychological evaluations on clients who live on the other side of the country. Psychologists can provide services in differ- ent locations while maintaining access to patient information through Aelectronic health records (EHRs) or cloud storage. Telehealth technology has also made it easier for psychologists and patients unable to meet in the same physical space due to long travel times. While there is greater flexibil- ity in providing psychological services, practitioners must consider the varied options, the legal and regulatory implications and the ethical considerations of technology when incorporating it into a practice. ONLINE ASSESSMENTS inpatient psychological and neuropsycholog- There are companies that currently offer ical evaluations with adolescents, adults and web-based platforms of assessment older adults. In his practice, he uses Pearson’s measures that can be purchased for psycho- Q-Global web-based system to administer and logical evaluations. PAR iConnect and Pear- score certain tests in addition to the traditional son’s Q-global are two online assessment paper and pencil formats. platforms currently available to mental health “Some measures are administered to the providers. These platforms enable providers patient during a testing appointment and to administer on-screen assessments in their others are sent electronically to the patient’s offices or allow clients to complete assess- parents or teachers to complete at their leisure. ments remotely on their own through the I try to limit the number of computer-based online portal. Some benefits of these plat- tests, though, because I believe that the truly forms include: interactive tests are superior,” Phillips says. While web-based assessments offer » flexibility—the ability to purchase specific several benefits, there are also some poten- measures and generate reports; tial concerns. For example, Phillips says » portability—measures can be completed interactive tests where the patient and the almost anywhere; and psychologist are in the same room may be » efficiency—being able to complete measures remotely can potentially save time. Both platforms have extensive libraries of assessments, but it is important to note that the tests offered by the two publishers are not the same. For instance, Q-Global has the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) while iConnect has the Reyn- olds Adaptable Intelligence Test (RAIT). Both platforms are compliant with the Health Insur- ance Portability and Accountability Act (HIPAA) and offer high levels of security for transmitting, accessing and storing assessments. Derek Phillips, PsyD, a clinical neuropsy- chologist in the Department of Neurology at the Sarah Bush Lincoln Health Center (SBLHC) in Mattoon, Illinois, conducts outpatient and 14 GOOD PRACTICE WINTER 2019 superior for ensuring validity because they TESTING AND TELEHEALTH are done in person. The validity of many Telehealth policies have opened up greater “I really like the measures relies on keeping the questions opportunities to offer assessments to people and answers secure. While allowing clients who may not have been able to access telehealth system. to complete the measures offsite may allow specialty services. for flexibility, it also opens the potential for Dustin Hammers, PhD, ABPP-CN, chair of We can deliver the copyrighted test materials to be shared the APA Committee on Rural Health and clini- improperly with others. It is also possible for cal director of neuropsychology services at the services to folks who results to be skewed by factors outside of the Center for Alzheimer’s Care, Imaging & Research, psychologist’s control, such as loud noises in University of Utah, is actively embracing the use otherwise wouldn’t the local coffee shop where a client chooses of telehealth—defined as services provided in to complete the measure. real time via interactive audio or video telecom- get them.” Finally, it is always relevant to consider the munications—in patient evaluations. Hammers’ cost of using a web-based platform for assess- practice is located in Salt Lake City, Utah, but ments and scoring. Companies will gener- he also provides services to clients in Jackson, DU STIN HAMMERS, ally charge for each measure template you Wyoming, through a relationship with a local PhD, ABPP-CN purchase, but different companies may also hospital. (Hammers is licensed in both Utah and charge a fee for generating the score reports Wyoming.) The patients Hammers sees often and more expensive interpretive reports. Prac- travel great distances to Jackson for these titioners could potentially save money by evaluations. opting to receive score reports over interpre- One concern about conducting evaluations tive ones, Phillips says. If you are considering via telehealth is how to handle an emergency a web-based system to supplement your exist- situation. Another issue is how to respond in ing battery of tests, you will want to review all the event of technology failure or disruption. the options to determine which program’s cata- Hammers’ practice employs a trained neuro- log of measures and payment structure best fit psychological technician on-site, sitting in the your practice and needs. room with the client while Hammers remotely GOOD PRACTICE WINTER 2019 15 TrendS and OPPORTUNITIES conducts a full clinical interview. The techni- TIPS FOR GETTING STARTED cian is on-site to support the client in case of Technology has the potential to open doors to emergencies and to administer the cognitive mental health treatment and assessments for measures as part of the evaluation. Hammers patients who aren’t familiar with the work that points out that with the use of telehealth tech- psychologists do and how they can help. nology, his patients in Wyoming get the same If you are considering adding a techno- evaluations, including the same test battery, logical component to your testing practice— as his patients in Salt Lake City. “I really like For whether it is utilizing a web-based platform the telehealth system because it is a way to or testing via telehealth—you must do your provide services to people in rural and fron- Consideration research. “My main advice is to do your tier areas. We can deliver services to folks who research before purchasing the specific tech- otherwise wouldn’t get them.” nology to be sure that it can offer the service Psychologists must take into consideration you are seeking. Also, if you are using this different factors when using telehealth technol- CAN YOU USE IT? technology specifically to administer tests, ogy with patients—for testing and therapy: Competency is take sufficient time to peruse the system after necessary in case purchasing before using it with patients,” Phil- » Does the psychologist have the compe- technology issues lips says. tence to use the system properly? arise Hammers also suggests openly communi- Before using any telehealth platform system cating with other health care providers in the with patients, it is important to familiar- areas you are servicing to gather information ize yourself with the technology and have about differences in culture—in his case, people a plan in place in case any issues arise. DOE S THE are coming from very remote settings and there Hammers has a technician in the room with PATIENT is still a lot of stigma with mental illness. In his his clients should problems come up but UNDERSTAND? work with patients in Wyoming, for example, that may not be possible for all clinicians. Educate the patient Hammers uses the phrase “speak with some- » Does the patient consent to using tele- about the process one” rather than “work with a therapist” due health technology and does he/she have and limitations to that stigma. “My recommendations have to the capacity to do so? be relevant to patients in rural Wyoming. Any The patient should be educated on how the recommendation that can be personalized for evaluation will proceed and the benefits as the patient has more power.” well as the limitations in doing an evaluation IS IT COMPLIANT? via telehealth. The platform RESOURCES » Is the telehealth technology you’re must be HIPAA- There are numerous publications, trainings and considering compliant with privacy and compliant resources available for psychologists who are security regulations? (unlike Skype) looking to expand their use of technology in Psychologists must use a HIPAA-compliant their testing practices. Visit APA.org to gather telehealth platform that utilizes the appropri- information on APA’s telehealth guidelines. ● ate encryption, secure transmissions, audit IS IT RELEVANT? trails and breach notification processes. Culture differences For example, Skype is not considered a can affect the HIPAA-compliant telehealth platform. While features you need in Skype uses encryption that exceeds federal a system, and how requirements, it does not offer audit control you communicate tools for monitoring who has access to your services patients’ protected health information (PHI); it does not provide notifications in the event of a breach; and it does not include appropri- ate controls for backing up of