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位置提供医疗保健服务的范例。近年来，远程医疗已扩大到包括各种远程提供的服务，包括生命体征监测、药物管理、“远程精神病学”等。对这些服务的日益利用是由成本驱动的，对于偏远地区，则是由于对本来无法获得的服务的需求。本提案旨在开发一种计算机化认知和行为精神评估系统，该系统能够以类似的方式远程管理各种常用的认知测试仪器和行为精神测量，就像考官坐在受试者旁边一样。拟议的远程检查员计算机评估系统（CARES）将使合格的检查员能够在远程位置对患者进行全面的认知和行为评估，否则可能会因各种成本因素而被禁止。偏远地区将包括农村和大城市地区的初级保健医生办公室、护理设施、治疗诊所和卧床病人的家中。CARES将实施一种全新的方法，远程检查者可以查看全屏辅助显示器，该显示器为GUI提供屏幕控制，以进行全面的管理和评分。考官将能够控制测试会话的节奏，重复和补充计算机化的指令（以确保理解任务要求），立即对口头报告或真实的明显行为进行评分，并暂停或终止测试。值得注意的是，CARES是以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，受试者由人类检查员陪同。高速、极低延迟、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中自由交互，这对于需要口头报告或行为表现的交互式评分的测试至关重要。因此，CARES将适用于可能需要持续监测和补充指导的受损人群。CARES测试集将由已建立的仪器的计算机化版本组成，通常应用于临床环境、研究和临床试验（例如，AVLT，轨迹A/B，语言流畅性，字母-数字，符号-数字，时钟绘制）。因此，CARES方案与现有的基于网络的评估形成鲜明对比，这些评估不仅没有检查员陪同，而且还存在严格的管理程序以及多种技术缺陷，这些缺陷显著限制了可以可靠地向受损人群管理的测试仪器的范围。在第一阶段，主要目标是评估人机界面的可行性，并评估在正常和受损受试者的认知评估的远程管理的可行性。CARES将是同类系统中的第一个，并将立即应用于医疗保健提供网络，研究环境和对照临床试验。公共卫生相关性：CARES构成了一种全新的认知评估管理方法，远程检查者可以管理广泛的认知和临床评估，而无需亲自出现在给定的站点。这对农村地区尤其重要。这项技术将降低专业评估的成本，并立即应用于医疗保健系统、研究环境和对照临床试验。

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.