“My father’s a neurologist. He’s a private physician and he’s part owner of his group in south Georgia,” says Jose Posas, MD, a neurologist with the Concussion Management Program at Ochsner Health System in New Orleans. “The practice of neurology for him and me… is totally different.” Dr. Posas is talking especially about the digital tools physicians have access to now.
His dad isn’t digging his heels in against the new stuff, though. “We share ideas,” says Posas. “We both agree that treating migraines and treating headaches and other things sort of requires using apps and utilizing the digital milieu in which your patients live.”
As a sports concussion specialist, Posas has patients (along with their coaches, parents, and team owners) who are especially interested in how technology can be used to better diagnose and treat concussions. He is daily immersed in this issue, but he understands the challenges of those who need help navigating the new tools. For this reason, he recommends people start where they are most comfortable.
If you are old school, start here
The SCAT5 is a pen-and-paper test that you can download or fill out online. “It’s made [this way] for a reason,” says Posas, “because the international concussion consortium decided to make something that was accessible to everybody, without having to have a paywall in front of it.”
The SCAT5 includes a list of red flags and has places to record observable signs like issues with balance or eye movements. It tests memory and the patient’s ability to do simple calculations. “All of us [neurologists] at some point were trained on some cognitive examination like the Mini-Mental State Exam or the Montreal Cognitive Assessment. This is the concussion-specific tool for that. It’s not the most sensitive, but it’s somewhere to start. For a private neurologist, the SCAT5 is very, very useful.”
If you are moderately tech-savvy, start here
“One of the big giants out right now is called the ImPACT test.” This 25-minute neurocognitive test is administered via computer and measures things like reaction time, as well as visual and verbal memory. It is not cheap, though. “Somebody has to foot the bill for it, whether that falls on the doctor’s office, or an arrangement with the school district, or philanthropy funds.” Posas says at Ochsner it is covered by the latter.
“ImPACT is a useful tool, but there are other ones out there: CNS Vital Signs, Cogstate, and Axon Sports.” Each of these tests is administered by computer and comes in at a different cost. “For someone looking to expand their practice it may be worth looking at the price points,” says Posas, because there is actually a reimbursement code you can use. That CPT code is 96120—neuropsychological testing by a computer.
In the second part of this article, we bring you more recommendations from Posas, including where to start when you want to be on the cutting edge. He also has a few words of warning when using any digital tools.