Taylor Internal Medicine in Selma, Alabama, was using a computerized cognitive assessment tool that just was not working as well as staff would have liked to see such a tool function. The biggest frustration was the time it took to administer a test; this was long and difficult for staff and patients. The tool also was more expensive than the clinic thought was reasonable.

PROPOSAL

In March 2018, Taylor transitioned from that cognitive testing platform to BrainCheck Memory's digital testing platform. The goals of the switch were to drastically cut the time it took to administer a test and to trim the costs of the test itself.

Dr. Bruce Taylor, owner of Taylor Internal Medicine, noticed several inconsistencies when administering tests on the previous platform. "It took our patients 30 minutes to complete the tests, and we were starting to receive complaints from them," Taylor said.

MARKETPLACE

There are a variety of computerized cognitive assessment tools on the market today. Vendors of these tools include Anam4, Cambridge Cognition, CNS-VS, Cognitrax, Cogstate and ImPACT.

MEETING THE CHALLENGE

Taylor staff routinely survey patients that come into the office, especially seniors, to check symptoms and see if they are experiencing any cognitive or memory concerns.

"For the folks who have positive responses to that survey, high-risk individuals, the provider will order the BrainCheck test," Taylor said. "We have MAs who are trained to administer the test. The tests usually take around 15 minutes and the results are immediately available in the app. But that's just a snapshot that the technician might use to check to make sure the test was administered correctly."

There also is the clinical report that provides much more information, including scores, impressions and recommendations. That report gets exported as a PDF and input right into the patient's chart in the clinic's EHR, Amazing Charts.

"I also like to have the MAs print out the report so that I can review with the patient, and caregiver if present," said Taylor. "That initial assessment helps to identify those folks who may be at high risk for memory loss and some of the impairments and problems people have with activities of daily living. Especially older people, as memory loss and other symptoms of dementia come into play."

Depending on the results, the provider will decide which intervention may be necessary. Sometimes staff may need to refer patients to home health so there's another set of eyes watching them. Sometimes it may mean either adjusting or adding medications, or perhaps a referral to physical therapy.

"Just having the conversation with the patient and family members about the results of the test can be valuable," said Taylor. "Often people suffering from cognitive decline are in denial about their condition and the same goes for families. 'Oh, mom is just forgetful sometimes.' Having an objective measure such as BrainCheck provides a way to communicate that impairment to the family."

RESULTS

The time it takes to take a test has been reduced from 30 minutes to 15 minutes.

"The test is shorter but it's also simpler and easier to understand for patients," Taylor said. "You can tell the company really puts an emphasis on the ease of use. For example, each test begins with interactive instructions. Also, administering the test on an iPad — with the touchscreen — is much more intuitive and user-friendly, even for seniors who may not be technologically savvy."

The new technology also has allowed staff to test more patients because technicians now have more bandwidth. "Due to the tests taking about half as long, it allows the techs to increase their throughput and also frees up their time to help with other areas of the practice," Taylor added.

And costs came down with the new technology. It cost nearly double to administer a test with the previous technology, Taylor said.

ADVICE FOR OTHERS

"Make sure you have plenty of training for your staff," Taylor advised peers who may be about to use the same or similar technology. "Before choosing a cognitive assessment platform, I would look to make sure that the testing company offers some sort of free one-on-one training for you and your staff. This will help maximize your opportunity for success."