Computerized Assessment by Remote Examiner System (CARES)

描述(由申请人提供)：远程医疗是一种通过电子连接向远端地区提供医疗服务的范例。近年来，远程医疗已扩大到包括广泛的远程交付服务，包括生命体征监测、用药管理、“远程精神治疗”和其他服务。这类服务的使用率增加是由成本推动的，对于偏远地区来说，则是对原本无法获得的服务的需求。本提案旨在开发一个计算机化的认知和行为-精神病学评估系统，能够以类似的方式远程管理各种常用的认知测试工具和行为-精神病学措施，就像考官坐在受试者旁边一样。拟议的远程检查计算机化评估系统(CARE)将使合格的检查人员能够在偏远地点对患者进行彻底的认知和行为评估，否则这些评估可能会因各种成本因素而被禁止。偏远地区将包括农村和城市地区的初级保健医生办公室、护理设施、治疗诊所和非门诊患者的家。CARE将实施一种全新的方法，即远程考官查看全屏二级显示，为图形用户界面提供全面管理和评分的屏幕控制。考官将能够控制考试的节奏，重复和补充计算机指令(以确保理解任务要求)，立即对口头报告或公开行为进行实时评分，并暂停或终止考试。值得注意的是，CARE是先前经过验证的、双显示器、计算机化评估系统的扩展，在该系统中，受试者由人类考官亲自陪同。高速、极低延迟的无线第三代/第四代(3G/4G)连接将允许受试者和考官通过高分辨率音频-视频接口在整个会话期间自由交互，这对于需要对口头报告或行为表现进行交互评分的测试至关重要。因此，CARE将适用于可能需要持续监测和补充指导的受损人群。CARE测试集将由临床设置、研究和临床试验中常用的已有仪器的计算机版本组成(例如，AVLT、Trails A/B、语言流利性、字母数字、符号数字、钟表绘制)。因此，CARE计划与现有的基于网络的评估形成鲜明对比，后者不仅没有审查员陪同，而且存在僵化的管理程序和多重技术缺陷，这大大限制了可以可靠地向残疾人口实施的测试工具的范围。在第一阶段，主要目标是评估人机界面的可行性，并评估在正常受试者和受损受试者中远程管理认知评估的可行性。CARE将是此类系统中的第一个，并将立即应用于医疗保健提供网络、研究环境和受控临床试验。公共卫生相关性：CARE构成了一种全新的认知评估管理方法，在这种方法中，远程检查员可以管理广泛的认知和临床评估，而不必亲自出现在给定的地点。这与农村地区尤其相关。这项技术将降低专门评估的成本，并立即应用于医疗保健提供系统、研究环境和受控临床试验。

DESCRIPTION (provided by applicant): 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.