CHA Innovations: Neuropsychology services using Telehealth


As CHA continues to expand its tele-health capabilities, we are excited to announce the launch of tele-neuropsychology (NAPA, Neuropsychology and Psychological Assessment) clinic. This clinic lets us evaluate patients for a variety of cognitive deficits (e.g., attention, memory and language issues) due to brain illnesses, in a safe and socially distant way.

While tele-neuropsychological services have been used in rural communities for over a decade, CHA’s Margaret Lanca, PhD, has been at the national forefront of refining the modality and helping spread its use during the pandemic. As part of the Interorganizational Practice Committee for Neuropsychology (IOPC), she has presented at two national webinars and has co-authored two articles which have been accepted and will be released this fall.

At CHA, she has been working with colleagues and postdoctoral fellows to configure this innovative service. This is a challenge because neuropsychology is typically a hands-on, interactive discipline. Neuropsychologists administer 100s of tests, many of which require precision of administration and careful observation of patient responses, in order to diagnose cognitive deficits and disorders.

To make this work effectively, CHA has set up a socially distant clinic that allows remote interaction and observation. It works as follows: the patient enters a room and sits in front of a desk with two computers. Both computers have monitors with cameras, one pointed at the patient, and one pointed at the desk. The desk has paper and pen, which can be used by the patient during some of the tests. The clinician is seated in a separate room, and guides the patient through the evaluation while observing the patient responses.

We feel this tele-neuropsychology approach is a best practice for the field at this stage of the COVID-19 pandemic which requires attention to social distancing, especially for prolonged appointments such as neuropsychology which can take several hours. It allows us to control many of the variables necessary for effective remote service delivery, maintain test security which is risky with at-home telehealth delivery, as well as reduce the barriers of access to healthcare and the disparities seen in our patient population. Accurate neuropsychological testing, done remotely, requires that patients have access to a computer, reliable high-speed internet connection and home privacy, which many of our patients do not. Digital literacy is also an issue that can be overlooked in telehealth, and for patients who are being evaluated for cognitive deficits, this is a salient consideration. In this in-clinic tele-neuropsychology set-up, patients have a computer that is easy to use and set up specifically for this interaction.

Making this work at CHA took several months of collaboration. We had to determine which tests could be reliably administered remotely, establish which tests had tele-neuropsychological equivalency to in-person testing, and work with the IT team to configure the technology. This was accomplished in August, and we launched the NAPA tele-neuropsychology service for adult patients on August 24, 2020.

Cambridge Health Alliance

Contributed By: Cambridge Health Alliance

Cambridge Health Alliance is an academic community health care system committed to serving all members of our communities. We have expertise in primary care, mental health and substance abuse, and caring for diverse and complex populations. CHA patients receive high quality care in convenient neighborhood locations, and have seamless access to advanced care through CHA’s affiliation with Beth Israel Deaconess Medical Center. With over 140,000 patients in Cambridge, Somerville Everett and Boston’s Metro North, CHA is working hard to offer the integrated services its communities need now, and in the future.