SBIR-STTR Award

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.

Public Health Relevance:
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.

Public Health Relevance:
O'Halloran, James P. COMPUTERIZED ASSESSMENT BY REMOTE EXAMINER SYSTEM 2. PROJECT NARRATIVE 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. NeuroComp Systems, Inc. (c) 2007 Page 1

Thesaurus Terms:
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Telemedicine can be defined as 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 telemedicine is driven by cost and, for distal (""underserved"") regions, a lack of professionals to deliver otherwise unavailable services. This proposal aims to develop a computerized assessment system capable of providing remote, audio-video-based administration of a wide range of commonly applied cognitive test instruments as well as behavioral-psychiatric measures (BPMs), in a similar manner as if the examiner were sitting face-to-face with the subject being evaluated. The proposed Computerized Assessment by Remote Examiner System (CARES) will enable qualified clinicians to remotely conduct thorough neuropsychological or psychiatric evaluations of research subjects or patients with a range of acquired brain disorders for which such assessments are routinely applied, including: traumatic brain injury, stroke, brain tumor, neurotoxicologicalinsult,HIV-relatedencephalopathy,schizophrenia,and Alzheimer's disease. Remote locations broadly include clinical evaluation units at hospitals, managed care facilities, group practice sites, nursing homes, correctional facilities, regional health clinics, and in patient's homes, in both rural and metropolitan areas. The CARES will implement a fundamentally new approach in which a remote examiner views a full-screen, application-specific GUI that provides on- screen controls that will enable an examiner to: control the pace of the test session, repeat and supplement computerized instructions, immediately score verbal report or overt behavior in real time, and pause or terminate a test. Thus, the CARES is well suited for application in impaired populations that commonly require ongoing monitoring and supplemental instruction. Significantly, the CARES is a technological extension of a previously validated, dual-display, computerized assessment system in which the subject is physically accompanied by a human examiner. The GUI for this antecedent system will be adapted to host a high-resolution televideo window that permits an examiner and patient to see and talk to each other, establishing high-quality ""telepresence"", which is especially important for the administration of tests or BPMs involving subjective impressions or judgement of overt behavior. Accordingly, the CARES approach 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 individuals. In Phase II, the main objectives are to: 1) develop an application- optimized, standardized, mobile CARES Hardware Platform (CHP) with integrated peripheral devices and software utilities;and 2)compare the concurrent validity, test-retest reliability, and user acceptability of accompanied computerized testing vs. remote computerized testing. The CARES will be the first system of its kind and will likely find immediate commercial application across a range of healthcare delivery networks, research settings, and controlled clinical trials. , ,

Public Health Relevance:
The Computerized Assessment by Remote Examiner System (CARES) is a unique and highly innovative technology intended to facilitate televideo-based neuropsychological and psychiatric evaluation services in areas that are currently ""underserved"" due to either geographic or economic obstacles that limit access to properly trained professionals who provide such services. Among these underserved populations are individuals living in rural areas or remote regions such as Indian reservations, individuals incarcerated in correctional facilities, and a variety of ""homebound"" individuals such as non-ambulatory patients or residents of nursing homes. The need to provide otherwise unavailable mental health services to these patients is a pressing disparity that the current project hopes to address.

Thesaurus Terms:
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