Table 2.
Technologies used in remote cognitive assessment in adult populations in the USA
| Technology | Number of users (% of total sample, n = 87) | Duration of use of the specific tele-health technology | Reason(s) for use | Challenges encountered, if any | Resolutions, if any | Mean recommendation level (1–10) |
|---|---|---|---|---|---|---|
| Zoom | 54 (62.1%) |
<1 year: 53.7% 1–4 years: 38.9% 5–10 years: 7.4% |
Mandated/only option at work: 57.4% HIPAA Compliance: 68.5% Cost (most economical): 9.3% Ease of use for examiner: 31.5% Ease of use for examinee: 31.5% Did not know about other options: 3.7% Popularity: 31.5% Other: 3.7% |
No challenges: 51.9% Connectivity problems (nonspecific to Zoom): 33.3% Patient/participant difficulty with platform: 13.0% Technological problems specific to Zoom (e.g., time-limit on free version and nonintegration with some software): 13.0% Issues with video/audio quality (specific to Zoom): 5.6% |
Do a practice call with the patient (or have administrative staff do a practice call); improvise or call examinee to walk them through difficulties; reconnect/restart meeting; reschedule to in-person or use a backup technology; use only audio for the visit; purchase pro Zoom account | 8.17 (SD = 1.44); range: 5–10 |
| Doxy.Me | 18 (20.7%) |
<1 year: 88.9% 1–4 years: 11.1% |
Mandated/only option at work: 50% HIPAA compliance: 61.1% Cost (most economical): 33.3% Ease of use for examiner: 16.7% Ease of use for examinee: 22.2% Popularity: 5.6% Other (good compatibility with document camera/good screen sharing): 5.6% |
No challenges: 33.3% Poor audio/visual quality: 33.3% Issues with technology (specific to Doxy.Me): 16.7% Patient/participant difficulty with platform: 5.6% |
Use audio only; use telephone call for backup audio; restart visit; have participant switch web browsers | 6.39 (SD = 2.66), range: 1–10 |
| MyChart (or EPIC Equivalent) | 16 (18.4%) |
<1 year: 56.2% 1–4 years: 31.3% 5–10 years: 6.3% >10 years: 6.3% |
Mandated/only option at work: 100% HIPAA compliance: 43.8% Ease of use for examiner: 6.3% |
No challenges: 25% Connectivity problems (nonspecific to MyChart): 25% Patient/participant difficulty with platform: 37.5% Poor audio/visual quality: 12.5% Issues with technology (specific to MyChart): 18.8% |
Use hospital administrative/IT help to resolve problems; use telephone call or a different platform as backup; reschedule the visit to in-person for testing; call examinee ahead of time to inform them of instructions about how to join visit | 6.81 (SD = 2.26), range: 1–10 |
| VA Video Connect | 14 (16.1%) |
<1 year: 71.4% 1–4 years: 21.4% 5–10 years: 7.2% |
Mandated/only option at work: 92.8% HIPAA compliance: 50% Cost (most economical): 7.2% Ease of use for examiner: 21.4% Ease of use for examinee: 21.4% |
No challenges: 14.3% Connectivity problems (nonspecific to VA Video Connect): 35.7% Patient/participant difficulty with platform: 35.7% Poor audio/visual quality: 14.3% Issues with technology (specific to VA Video Connect): 14.3% |
Use telephone call; use alternate telehealth technology; reschedule for in-person testing | 6.43 (SD = 2.07), range: 2–9 |
| Facetime | 8 (9.2%) |
<1 year: 50% 1–4 years: 12.5% 5–10 years: 25% >10 years: 12.5% |
HIPAA compliance: 12.5% Cost (most economical): 12.5% Ease of use for the examiner: 25% Ease of use for the examinee: 75% Popularity: 25% |
No challenges: 50% Cannot block personal cell phone number: 12.5% Concerns about security of the session/limitations of the platform for visual test stimuli: 37.5% |
Facetime used as a last resort if examinee not able to use other platform; examiner blocks examinee’s number on phone after session; only use a limited test battery | 6.38 (SD = 2.39), range: 3–10 |
| Microsoft Teams | 5 (5.7%) |
<1 year: 20% 1–4 years: 80% |
Mandated/only option at work: 100% HIPAA compliance: 40% Cost (most economical): 20% Ease of use for examiner: 20% Ease of use for examinee: 20% Popularity: 40% Integration into software at work: 20% |
No challenges: 60% Poor audio/video quality: 20% Loss of visibility of examinee when sharing screen: 20% |
Removal of timed-exposure tasks or administration of these tasks at a later date in-person; use telephone call as backup | 7.20 (SD = 0.84), range: 6–8 |
| Skype | 2 (2.3%) |
<1 year: 50% >10 years: 50% |
Popularity: 50% Other reason (other technologies did not work): 50% |
Not always functional: 50% General connectivity problems: 50% |
Reschedule assessment; use telephone as backup | 3.50 (SD = 2.12), range: 2–5 Note: 2 raters only |
| Other technologies: (Doximity, Google Meet/Gsuite, WebEx, and other miscellaneous technologies) | 22 (25.3%) |
<1 year: 77.2% 1–4 years: 18.3% 5–10 years: 4.5% |
Mandated/only option at work: 54.5% HIPAA compliance: 59.1% Cost (most economical): 36.4% Ease of use for examiner: 22.7% Ease of use for examinee: 27.3% Other (scheduling/sharing documents): 13.6% |
No challenges: 50% Connectivity problems (nonspecific to the telehealth technology): 18.2% Patient/participant difficulty with platform: 13.6% Technology problems (specific to the telehealth platform): 13.6% Poor audio/video quality: 9.1% |
Restart session; reschedule testing for in-person session; use telephone for backup audio; switch to a different telehealth technology; troubleshoot on internet search engine | n/a—various technologies included in “other” |