An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will conduct a study to review the latest published research and science and produce a report based on published evidence (to the extent possible) and professional judgment (where published evidence is lacking) addressing best practices and known limitations in the use of telehealth and remote testing procedures to measure functional capacity and medical severity in connection with disability evaluations, including:

1. Describing the recent history of telehealth usage and best practices, including:

a. A brief overview of how the provision of telehealth services changed with the onset of the COVID-19 public health emergency (PHE) on January 31, 2020;

b. Changes in the prevalence of telehealth services being offered or provided since the end of the COVID-19 PHE on May 11, 2023; and

c. Flexibilities in the provision of remote medical services enacted during the PHE that have been made permanent or that remain in place;

2. Describing the current general practice landscape for the use of telehealth services by the medical community, including:

a. Types of medical providers or specialties most and least likely to offer telehealth appointments;

b. Best practices for telehealth appointments that encourage the creation of robust and reliable clinical notes;

c. What services or tests are routinely provided via telehealth and any modifications necessary for their remote provision;

d. What types of patient-oriented technological services or supports have been found most helpful to facilitate effective telehealth usage;

e. Any differences in the use of telehealth services, or best practices when using those services, between adult and pediatric patient populations; and

f. Contraindications for the use of telehealth in specific patient populations or for patients with specific characteristics or impairments;

3. Within the area of psychiatry, psychology, and mental health care:

a. Are there comprehensive intelligence tests designed and normed for remote administration;

b. For any tests identified in (a), how do the psychometric properties of these tests compare to benchmark intelligence tests for equivalent patient populations such as the Wechsler Adult Intelligence Scale or Wechsler Intelligence Scale for Children;

c. For common comprehensive intelligence tests not designed or normed for remote administration including the Wechsler Adult Intelligence Scale or Wechsler Intelligence Scale for Children, describe alterations in administration that would allow for remote administration and the implications of those alterations on the tests’ psychometric properties;

d. Are there standardized psychological tests, other than intelligence tests, designed and normed for remote administration that may be beneficial in the Social Security disability evaluation process; and

e. Are particular psychological signs more likely to be missed by providers during a mental status examination or excluded from resulting documentation when an individual is seen via telehealth, and are there best practices that can mitigate these deficits;

4. Within the area of orthopedics, rheumatology, and musculoskeletal disorders:

a. Are there valid and reliable methods for measuring range of motion, gait, strength, or related functional concepts through remote testing;

b. Are there other aspects of musculoskeletal or joint dysfunction that can reliably be identified or measured through remote examination methods; and

c. For any methods identified in (a) or (b), what aspects of test or examination administration procedure or facilitating technology are necessary to ensure valid and reliable test or examination results;

5. Within the area of neurology and neurological disorders:

a. Are there valid and reliable methods for measuring involuntary movements, spasticity, dystonia, extraocular movements, coordination, balance, facial weakness, or related functional concepts through remote testing;

b. Are there other aspects of neurological dysfunction that can reliably be identified or measured through remote examination methods; and

c. For any methods identified in (a) or (b), what aspects of test or examination administration procedure or facilitating technology are necessary to ensure valid and reliable test or examination results;

6. Within the area of dermatology and skin disorders:

a. Are there current telehealth technologies capable of gathering images or other evidence of sufficiently high quality to enable remote diagnosis or routine post-diagnosis follow-up examinations for specific skin disorders; and

b. If so, what aspects of examination administration procedure or facilitating technology are necessary to ensure valid and reliable examination results;

7. Explaining, by medical specialty or impacted body system, other specific tests or examination procedures utilized during telehealth visits that may be beneficial in the Social Security disability evaluation process and, for each specific test or examination procedure:

a. Whether there are necessary differences in the method of administration when done via telehealth; and

b. Whether there are differences in the validity or reliability of these tests or procedures when administered remotely, and whether and how these differences can be mitigated.

The report will include findings and conclusions but not recommendations.