Telemedicine Cognitive Assessment Administration and Troubleshooting

Administering cognitive assessments via telemedicine may seem much different at first. However, for physicians using BrainCheck, the process remains essentially the same for tests delivered in-office or remotely. 

Getting Connected

The essential first step, regardless of setting, is confirming that the appropriate equipment is available on both the clinician side and the patients’

Often, a family member may need to assist the test taker with establishing the video link with the clinician or the assistant who will administer the assessment. This is particularly the case for patients with suspected cognitive impairment. 

For the clinician or technician, feeling confident with both BrainCheck and video-conference technologies can ensure that the everything is clear, simple, and free of technical glitches.

Getting Started

Next, the clinician or assistant should share with the patient the reason for testing and how they will administer the tests.  

Orienting the patient can be simple. For virtual visits that include a remote cognitive assessment, the clinician or technician can introduce the process to the patient with something like:  

“Have you ever talked to a doctor or office assistant on camera before? We will be talking today just like we were in the same office together. 

Please let me know if you have any problems seeing or hearing me. If you have any trouble hearing or understanding me, please let me know, and I’ll be happy to repeat myself. I will ask you to repeat if I have any trouble understanding you.  

I’ve taken steps to make sure that our visit is private and confidential. I will not record our visit. Please make sure as we continue to visit that you are in a place where you can expect privacy and be free of interruptions or distractions. As we get ready to begin, please sit in a comfortable position in a comfortable chair

Today, I’m going to have you use BrainCheck so that we can assess your memory and thinking.”

Remember that positive, assuring initial contact with the patient will reinforce their confidence in BrainCheck as a helpful assessment.

Troubleshooting Telemedicine Cognitive Assessment

Administering cognitive assessment via telemedicine may require troubleshooting from time to time. Often, clinicians can fix these problems easily with a few minor adjustments.

Audio and Connectivity Issues

The experience of the video-conference session is probably more negatively affected by poor audio than by momentary lapses in video, such as pixelation. 

Echo and delay are the most common audio problems in video conferencing. Either can significantly impair clinician and patient communication.  

Audio delay may result from inadequate or variable internet bandwidth. If these problems persist, the practice may need to upgrades to a higher bandwidth internet service. 

Clinicians can investigate echos or feedback, and typically correct the issue by adjusting  microphone and speaker placement. In many cases, the use of a USB headset/microphone or quality earbuds can eliminate audio issues. 

The clinician or technician should also have the patient’s telephone number on hand should the video-conference connection be lost or disrupted. Unless the clinician or technician can reestablish the video call immediately, quickly contact the patient by phone.

Preventing Interruptions and Distractions

Poor microphone placement can cause significant disruptions.

External video-conference microphones typically have high sensitivity. Placing these microphones on a small table away from the desk may prevent issues. 

Embedded microphones in typical laptop configurations are less sensitive. However, keystrokes, paper-shuffling, finger tapping or other extraneous noises that you may not notice in person can be very noticeable and aggravating to a patient in a video-conference setting.

Practitioners should establish that the patient has finished speaking before starting a new sentence. Any audio delay in the system will heighten problems with speaking over one another.While interrupting clients is poor form in the traditional office setting, the problems tend to be magnified in the telemedicine environment, to the point that loss of intelligibility can occur. 

Practitioners may want to ask patients to repeat themselves or regularly check to ensure understanding. 

Protecting Privacy

In the rare event that someone else could be in or enter the office, explanation should be provided and permission obtained from the patient. 

Should someone else remain in the office (for example, teaching or demonstration to another clinician), that individual should be introduced, consent to view should be obtained, and that individual should be moved off camera while patient care is conducted.

Be Proactive

Patient-focused care means guaranteeing a virtual office environment free from distractions. Cell phones should remain off or on vibrate. External noise (noises from adjoining offices, music, appliances) must be controlled wherever possible. 

BrainCheck recommends that clinicians and technicians review any disrupted sessions afterward to determine the source(s) of the problem. This makes any system adjustments necessary to prevent recurrences easier. 

The practitioner should encourage the patient to point out any difficulties in video or audio quality, and take corrective measures.  Some patients will feel reluctant to bring technical problems to the clinician’s attention. Practitioners may need to regularly check in during sessions to make sure that session quality continues.

BrainCheck Helps Practices Continue Providing Cognitive Care

Cognitive care remains essential for many patients. But the risks associated with COVID-19 and stay-at-home policies across the U.S. may have prevented patients from bringing these concerns to the attention of their physicians.

For practices offering telemedicine — or interested in adding telemedicine cognitive assessment services — BrainCheck provides a simple and effective tool for assessing cognitive function remotely. We offer a variety of resources on telemedicine to help practices get started. And with our free trial, practices can BrainCheck for 30 days to see the benefits of the platform.

Add remote cognitive assessment to your practice today! »


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About the author

Robert Cuyler, PhD


Robert Cuyler is a clinical psychologist with decades of clinical, management and consulting experience. He is a Clinical Advisor at BrainCheck and the chief clinical officer of Palo Alto Health Sciences. Previously, Dr. Cuyler served as the CEO of JSA Health Telepsychiatry and clinical advisor to MDLive/Breakthrough Behavioral. Dr. Cuyler received his PhD in psychology from Louisiana State University and his postdoctoral fellowship from the Menninger Foundation.

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