An IME can be a valuable tool in assessing an examinee’s health condition and neurosurgical status, including cognitive, spinal, and musculoskeletal functioning. The quality of an IME report depends on certain factors, some of which are outside the control of the independent neurosurgical examiner, including (i) the completeness of the medical records provided (which should include pre-incident records and diagnostic imaging studies on CD, if available) and (ii) the degree to which the examinee is willing to cooperate with the evaluation by:
- arriving on time (15 min early, if possible) to complete the standard office forms, which may include brain injury questionnaires (only after a concussion/brain injury);
- bringing relevant diagnostic imaging studies on CD; and
- providing a good verbal history.
An IME may not be conducted or may be of reduced quality if:
- the examinee arrives more than 15 minute late,
- the examinee does not bring diagnostic imaging studies on CD,
- the medical records are incomplete, and
- an interpreter is not provided when needed.
If an examinee is more than 15 minutes late or if an interpreter is needed but not available, the IME will need to be rescheduled.
A telemedicine IME poses several additional challenges and limitations and, like a traditional IME, depends significantly on the examinee’s willingness to cooperate. A physical examination, other than an observation, cannot be conducted during a telemedicine IME and the examiner’s ability to observe the examinee can be adversely affected by several technical factors, including poor lighting, camera position, and slow internet connection. Because of the limitation of a telemedicine encounter, the diagnostic accuracy is not as good as that of an in-person encounter, particularly to the extent that physical examination findings contribute to the diagnosis.