I first used Proctorio alone (with Blackboard). But since I allow students to use their notebook during exams, looking away from the monitor had to be allowed and this disabled a main restriction of Proctorio.
Then I experimented with requiring an external webcam in addition to the integrated one. The external webcam would stream student's table on Blackboard Ultra. This created several problems. (A) Students objected to the additional expense. (B) If you have two cameras on Windows only one is active so I had to disable the Proctorio's camera and just use Proctorio to record the screen. (C) Some students with OS other than Windows had a hard time with finding compatible cameras.
But overall the exam became as secure as in-class exam. The drawback was that I had to be there to observe them and for an asynchronous class this became a major time drain. I used a two-phase password to make sure students show up on the external webcam. I would make a "Gateway" test on Blackboard whose main job was to activate Proctorio and give students the first half of a password to their assignment (which is not on Blackboard). Then they come to check-in process on the live camera and once they pass they get the second half of their password.
Next I experimented with asking students to use their phones to stream themselves using Blackboard Collaborate Ultra (BCU) during tests. This meant student's profile, hands, monitor, keyboard, papers, calculator, etc. had to be in full view. The phone had to be securely placed at eye level or higher. I ask student to download the Blackboard Ultra app to their phone and open video on it during exams.
Now you have several options in terms of which video feed you want to view or record and if you want to have an open chat line with students.
Here are the restrictions and options:
(a) On the student laptop only one program can access the camera either Proctorio or Ultra not both. (However there is a software called ManyCam for dealing with multiple cameras, but I did not experiment with it.)
(b) You typically want to have a chat line with students and an Ultra session on the laptop is the natural place for it. Then the video on this Ultra should not be abled.
(c) You can generate a guest link on Ultra emailed to students and have students use that to open the Ultra on their phones and enable video.
(d) You can have multiple simultaneous sessions on Ultra. One for phone and another for the chat line.
(e) At most one audio should be open, otherwise you get an unpleasant feedback.
The major drawback of Ultra is that it allows only 4 video feeds at a time and does not let you pick a student's feed to inspect. You have to put them in "Break Out Rooms", 4 to a room, and the process becomes clunky. Ultra allows a maximum of 10 Break Out Rooms.
Probably Zoom will be more flexible with this issue. But with both guest access to Ultra and personal Zoom subscription there could be less of a secure connection.
My concern about students viewing the screen and seeing each others work or papers did not seem to be a significant issue. The image is too small to be of use.