Telemedicine is a paradigm defined by the delivery of healthcare services to distal locations by electronic connectivity. In recent years, telemedicine has expanded to include a wide range of remotely delivered services, including vital signs monitoring, medication management, """"""""telepsychiatry"""""""" and others. The increasing utilization of such services is driven by cost and, for distal areas, demand for otherwise unavailable services. The present proposal aims to develop a computerized cognitive and behavioral-psychiatric assessment system capable of remote, audio-video-based administration of a wide range of commonly applied cognitive test instruments and behavioral-psychiatric measures, in a similar manner as if the examiner were sitting next to the subject. The proposed Computerized Assessment by Remote Examiner System (CARES) will enable qualified examiners to perform thorough cognitive and behavioral evaluations of patients at remote locations that may be otherwise prohibited by various cost factors. Remote locations would include primary care physician's offices, nursing facilities, treatment clinics, and non-ambulatory patient's homes in both rural and metropolitan regions. The CARES will implement a fundamentally new approach in which a remote examiner views a full-screen, secondary display that provides GUIs with on-screen controls for comprehensive administration and scoring. The examiner will be able to control the pacing of the test session, repeat and supplement computerized instructions (to ensure understanding of the task demands), immediately score verbal report or overt behavior in real time and pause or terminate a test. Significantly, the CARES is an extension of a previously validated, dual-display, computerized assessment system in which the subject is physically accompanied by a human examiner. High-speed, very low latency, wireless Third/Fourth Generation (3G/4G) connectivity will permit the subject and examiner to freely interact throughout a session via a high-resolution audio-video interface, as is critical for tests requiring interactive scoring of verbal report or behavioral performance. Thus, the CARES will be suitable for application in impaired populations that may require ongoing monitoring and supplemental instruction. The CARES test set will consist of computerized versions of established instruments, commonly applied in clinical settings, research and clinical trials (e.g., AVLT, Trails A/B, Verbal Fluency, Letter-Number, Symbol-Digit, Clock Drawing). Accordingly, the CARES schema contrasts sharply with available, web-based assessments that are not only unaccompanied by an examiner, but suffer from rigid administration procedures, as well as multiple technical shortcomings, that significantly limit the range of test instruments that can be reliably administered to impaired populations. In Phase I, the main objectives are to evaluate the viability of the human-computer interface and evaluate the feasibility of remote administration of cognitive assessments in normal and impaired subjects. The CARES will be the first system of its kind and will find immediate application in healthcare delivery networks, research settings, and controlled clinical trials.
The CARES constitutes a fundamentally new approach for administration of cognitive assessments in which a remote examiner can administer a wide range of cognitive and clinical assessments without having to be physically present at a given site. This is particularly relevant for rural areas. This technology will decrease the cost of specialized assessments and find immediate application in healthcare delivery systems, research settings and controlled clinical trials.
