Cognitive Screening and Clinical Decision Support at a Distance
Cognitive Screening andClinical Decision Supportat a DistanceA presentation for the GeorgiaPartnership for TeleHealthMarch 15th 2012 Gregory Bayer, PhD Brain Resource, Inc
New Technologies for Cognitive Assessment and RemediationTechnologies Exist Today For Rapid Neuropsychological Screening• Psychiatric screening that can be done in under 10 minutes and at a distance with 85% sensitivity and 84% specificity for identifying risk across a broad spectrum of disorders.• Neuropsychological screening can be accomplished at home or in a clinic environment using a standardized and objective measure of emotional and cognitive skills plus self- reported measure of behavior in a 35 minute evaluation.• Brain health programs and biofeedback tools that can be used with minimal or no supervision at an individual’s own pace.These technologies allow providers to:• Obtain neuropsychological evaluation quickly, efficiently, and inexpensively• Support psychiatric diagnosis and medication decisions with objective cognitive markers• Improve diagnostic accuracy, permitting more individualized biopsychosocial treatment• Assess and monitor psychotropic mediations more effectively• Augment rehabilitation activities with a self-administered brain-health improvement program.
Integrative Neuroscience AssessmentScalable brain health assessments can be built from existingneuropsychological batteries and deployed via the web for easyadministration and use.Questions [Feeling and Self Regulation] (<5 min) “I Find it “I respond best difficult to to positive relax” feedback”Objective Cognitive Tasks [Emotion and Thinking] (30 min) Motor Choice Reaction Memory Emotion Digit Span Verbal Tapping Time Recognition Identification Interference Switching of Go/No-Go Delayed Emotion Continuous Maze Attention Memory Recognition Performance Recognition Test
A Web-Based Model of Psychiatric PracticeNeurocognitive assessments and brain training exercises can be used incombination to provide personalized assessment and treatment options. 1. Rapid Neurodiagonistic Screener Brief Screening 2. Identifies early risk for brain health condition 3. Broad spectrum screen with high sensitivity Assessment Neuropsychological 1. Objective & Rapid Assessment of strengths/deficits 2. Treatment decision support & change monitoring Assessment 3. Effective screener for ADHD, Depression, Dementia, TBI 1. Interactive Brain Training Training Program 2. Promotes Resilience 3. Remediates cognitive and emotional deficit areas Treatment Biofeedback-based 1. Heart Rate Variability training 2. Personalized Stress Management stress management 3. Adjunctive non-medicative therapy
BRISC For Mental Health ScreeningBRISC (Brain Resource brain health screen) includes 15 questions to assessNegative-Positive Bias, Emotional Resilience, and Social SkillsHelps identify individuals who have and/or are susceptible to a mental healthdisorder.Negativity Bias has 85% sensitivity an 84% specificity for identifying risk across abroad spectrum of disorders. Williams, Cooper, Wisniewski, Gatt, Koslow, Kulkarni, Gordon, Rush (2011). Sensitivity, specificity and predictive power of the “BRISC”, a cross-sectional study on a brief web screen for brain health. J Clinical Psychiatry (in review)
Cognitive Markers + Clinical Algorithms = Powerful Tools For Dx and Tx1. Assess core cognitive and emotional capacities2. Apply data-based clinical algorithms to individual responses3. Use resulting clinical profile to support practice-at-a-distancedecision making
Example Reporting on Resilience and Self-Control
Testing Supports Case Identification,Medication & Management
Sensitivity and specificity of web-based tests for ADHD Sensitivity SpecificityMarkers from• Sustained Attention• Impulsivity• Intrusions• Inhibition 88% 91%• Response Variability Williams LM, Using brain-based cognitive measures to support clinical decisions in ADHD. Pediatric Neurol. 2010 Feb;42(2):118-26.
CPT Code Information for Web-Based Testing Neuropsychological tests for clinical use 96116 96118 96119 96120 Neurobehavioral Clinician time for Technician time for Non-facilitated Status Exam facilitating test facilitating test test administration Clinician time for administration administrationinterpreting results Clinician time for Clinician time for and report interpreting results Clinician time for interpreting resultsMost reimbursed in and interpreting results and reporttelehealth settings report and report Medicare PaymentMedicare Payment Medicare Payment Medicare Payment (Source: AMA (Source: AMA (Source: AMA (Source: AMA Website) Website) Website) Website) Non-facility = $78.85Non-facility = $72.61 Non-facility = $106.01 Non-facility = $72.89 Facility = $24.84 Facility = $66.91 Facility = $85.75 Facility = $25.63 ONE TIME CHARGE PER HOUR PER HOUR PER HOUR
MyBrainSolutions.com Brain Training Experience Know Your Brain Train Your Brain Optimize YourselfA brain assessment and report to discover Interactive games and exercises designed A dashboard with tools to monitoryour personal strengths/weaknesses and based on proven techniques to develop brain training results and progress towardspersonalize your training. healthy habits. achieving health goals.
Behavioral Change with Fun Online Tools Traditional behavioral change strategies made fun and accessible.Thought Challenger Relaxation Room Training with Positive Positive ReflectionsLearn about the connection A meditation room allows user to Affirmations helps Employees Writing down at least one thingbetween thoughts, feeling and practice relaxation strategies like develop positive self-talk in areas that went well each day is a tacticbehaving by challenging specific progressive muscle relaxation and where they often have negative to help strengthen our positivenegative thoughts and creating slow breathing. thoughts or doubts. For ex. ‘I feel memories. Positive Reflectionsmore productive thinking habits. healthy and happy’ vs. ‘I know I’m then encourages you to associate going to get sick soon’. any event with a person strength of yours to build a sense of self efficacy – that you have the power to influence your outcomes each and every day.
Non-medication Stress ManagementMyCalmBeat provides accessible, intuitive bio-feedback for membersto reduce stress, sharpen focus, and improve health outcomes 2. Train using your iPhone, iPod Touch, iPad, Blackberry, Android and over the web. Scie 3. Train using biofeedback on your desktop.Guides patients through 3 Stages: 1. Identification of Optimal Breathing Rate 2. Training 3. Progress Monitoring