A number of AGS members have alerted us to changes in the terms of use for the Montreal Cognitive Assessment (MoCA), announced in an email from Dr. Ziad Nasreddine, the founder of MoCA Test Inc. Dr. Nasreddine holds the copyright to MoCA.
AGS members are collaborating on an editorial for the Journal of the American Geriatrics Society (JAGS) that will lay out some of the implications of this change and potential strategies geriatrics could take in response. The AGS will be reviewing ways it can support members in identifying alternate instruments in the public domain, with the goal of ensuring members are aware of validated instruments that can support the care of older adults.
This post summarizes some of the changes ahead for MoCA and is based on a review of the MoCA Terms of Use (https://www.mocatest.org/terms-of-use/), Permissions (https://www.mocatest.org/permission/), and Privacy Policy (set forth in the Terms of Use). We encourage members who wish to continue using MoCA in clinical practice, education, and research to review all the policies available at www.MoCAtest.org before completing the registration process.
Important Dates
September 1, 2019: You must register for training at MoCAtest.org and will have one year to complete the required training to become certified. During this year, you still will be able to use MoCA.
September 1, 2020: After this date, you will not have access to MoCA if you have not completed the training and received certification. The website notes that training is required to “insure consistency and accuracy” in administering and scoring the test.
Cost
Training is $125/person and certification is valid for two years, after which you will need to complete the training again. MoCA Test Inc. specifies there are options for institutional licensing. The MoCA instrument itself will remain free.
Permissions
You must request permission to reproduce MoCA in print. Posting MoCA to the web, developing an electronic version of MoCA, or developing materials related to MoCA are expressly prohibited.
The Data MoCAtest.org Collects
Health Care Professionals: To use MoCA, you will need to create a user account by registering at MoCAtest.org. Required personal information is (i) your name and surname, (ii) your email address, (iii) the country where you practice, and (iv) your profession and the institution(s) where you work (or are affiliated). In its privacy policy, MoCA Test Inc., states that your personal information will only be used as provided for under its privacy policy. Examples provided are: (i) for confirming and tracking your order; (ii) for subscription or registration; (iii) for analyzing preferences, trends, and statistics; and (iv) for informing you of new products, services, and offers, or as authorized by applicable law. The policy notes that your personal information will never be rented or sold. MoCA also specifies that it will not de-identify your information if requested to do so by a patient.
There are a number of other ways that MoCA intends to collect information about users. These include surveys, cookies, and buying information from third parties. We encourage you to review all the ways MoCA plans to collect information about its users.
Your Patients: Health professionals administering MoCA will be required to obtain consent from patients, and then register patients they screen using this test, including entering their answers. Answers will be analyzed robotically, and a score will be sent to you by email to counsel your patients and update their electronic health record. The de-identified Patient Personal Information that you will be asked to collect is: (i) your patient’s file number (provided that it is assigned randomly, cannot be used to identify the patient, and does not entail risks of re-identification (e.g., the code or other means of re-identification is not disclosed by you)), (ii) age range, (iii) gender, and (iv) level of education. This information is required to create a patient profile and link tests and results to profiles. MoCA will not request identifiable patient information.
MoCA states that it will not link test results to patient profiles. Instead, test scores will be sent to the email account you use when you register, and you can add the test to your patient’s medical record, per your legal and ethical obligations. It is important for you to know that you will bear all responsibility for complying with federal and state laws governing the privacy and security of your patients’ personal information, including medical or other data. MoCA specifies that it is not subject to the federal Health Insurance Portability and Accountability Act (HIPAA) and disclaims any representation or warranty that their website and application comply with HIPAA. You are required to agree that MoCA is not a business associate, subcontractor, or agent of yours under HIPAA.
MoCA Use of Data
MoCA will be collecting data on you and de-identified data on every patient you screen. MoCA states that it will de-identify health professional information, and this information and the de-identified Patient Information may be used on an aggregated basis by MoCA or any third-party vendor for improving the MoCA website and application, research purposes (including to improve overall knowledge about cognitive impairments), statistical purposes, or any other commercial and non-commercial purpose. MoCA retains the right to have your personal information reviewed by third parties as part of an overall assessment of the value of MoCA. MoCA provides an overview of the steps it has taken to guard your data, and states that any third-party vendor hired to work with your data will be required to agree to these safeguards.
Deletion of Your Account
You may edit or delete your account, profile or Personal Information at any time. MoCA does not specifically state whether it will retain or discard your de-identified data or the scores it has produced for your patients. Given the ways MoCA intends to use this de-identified data, the AGS assumption is that MoCA will retain all de-identified data on you and your patients following termination of your account.