Teleneurology Basics
Teleneurology uses real-time or delayed communication between neurologists and patients or neurologists and other providers through shared audio, video, secure messaging, and other data exchanges. It has been an essential tool in improving the health and quality of life of those restricted to quality neurological care. These restrictions on care are often due to geographic isolation. Here are some challenges for teleneurology, as well as some issues and limitations.
Certain areas lack a neurologist, or patients must travel long distances to receive care. Teleneurology has provided an outlet in which patients and physicians, although far apart, can communicate and be examined instantly. This is relevant for chronic conditions that require continuous follow-up or in emergencies, in which the administration of thrombolytic therapy in stroke, for example, is often needed within a short time to be effective.
Teleneurology in COVID-19 Pandemic
As we enter the second year of the COVID-19 pandemic, hospitals face increasing demand for neurology care against high costs and provider shortages. Besides their usual load of neurological emergencies, neurologists are treating an epidemic of COVID-19-related strokes in relatively young people. The pandemic has driven home the idea that neurologists don’t need to be physically present to examine patients, make clear recommendations, support in-person providers, and be integral parts of care teams.
In rural and underserved areas, there are restrictions in healthcare due to the lack of availability of neurologists; patients have to travel long distances to receive the required care. Because neurological conditions have significant mortality and disability rates, there is a need for innovative services like teleneurology. Adapting teleneurology is a powerful and creative way to enhance healthcare in areas with a shortage of specialists. Teleneurology can potentially reduce healthcare costs and hospitalization services, and improve multidisciplinary communication between different providers regarding the care for their patients.
As detailed above, there are numerous times in which teleneurology has a positive impact. Excessive costs, for example, can be reduced from $140-180 for in-person acute care to about $40-50 for a telehealth session; neurology practices have found evidence of lowered patient out-of-pocket expenses and institutional cost savings with telehealth utilization. There are also reduced travel costs and travel times associated with teleneurology, high patient satisfaction, reduced geographical disparity for general and specialized neurological care, and more educational opportunities for physicians available. There are several benefits to widespread adoption of telemedicine for neurology, as well as a few challenges for teleneurology that must be overcome.
Challenges for Teleneurology
For all the Challenges of Teleneurology, there are some issues and limitations.
- Significant upfront costs are required for equipment and telecommunication lines required for synchronous teleneurology. The equipment must be operated by trained staff, and sufficient connection bandwidth is required. Even then, some technology only allows one person to speak at a time.
- Additionally, doctors often do not have access to the electronic health records of the patients they consult. Some imaging and tests are also unavailable remotely, and the ability to conduct the neurological exam is often limited. Thus, many teleneurology practices only see a follow-up rather than new patients.
- Although asynchronous technology is inexpensive and convenient for high-volume and triage work, it does not allow the neurologist to take a history or see the exam conducted personally.
- Additionally, both synchronous and asynchronous teleneurology have been viewed as promoting a shift within neurology from securing a final diagnosis to more of a disease categorization type of work based on not-to-miss diagnoses. Clinicians have felt it is like ‘shooting in the dark at a moving target.’
- Teleneurology also has legal concerns. Since transmissions traverse the public Internet, sufficient encryption should be used to satisfy HIPAA requirements and ensure patient confidentiality and the safety of personal data. WhatsApp’s encryption, for instance, is not compliant and is not considered safe.
- There is also the problem of writing prescriptions; in the United States, one needs a license to practice in the state where the patient is located. Thus, out-of-state providers often cannot prescribe medication or order tests by telemedicine.
- Reimbursement is also frequently cited as a significant challenge to telemedicine; Medicare reimbursement is often difficult and requires specific service locations and appropriate sites to provide the healthcare, and many insurers only reimburse for in-person services.
The utilization of teleneurology has increased exponentially and is widely used for stroke, epilepsy, neurorehabilitation, pediatric neurology, outpatient consultation, drug refills, mental health evaluation, and global neurology. Tele-neurology is a powerful and innovative tool that enhances healthcare in the worldwide shortage of neurologists and other healthcare providers.
Patients benefit from time savings and reduced travel expenses. Physicians also save time, are exposed to a more diverse patient population, and have fewer missed appointments and cancellations. Though some experts believe that teleneurology has its limitations, it is an effective tool to open a new horizon in modern neurological care.
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FAQs
1. What is teleneurology and how does it work?
Teleneurology uses real-time or delayed communication between neurologists and patients or neurologists and other healthcare providers through shared audio, video, secure messaging, and other data exchanges. It allows neurologists to examine and consult with patients remotely, improving access to care, especially for those in geographically isolated areas.
2. How has the COVID-19 pandemic impacted teleneurology?
The COVID-19 pandemic has significantly increased the demand for teleneurology as hospitals face shortages of neurologists and higher demand for neurological care. Teleneurology has proven essential for treating COVID-19-related strokes and managing neurological emergencies without requiring the neurologist’s physical presence.
3. What are the benefits of teleneurology for patients and healthcare providers?
Teleneurology offers several benefits, including reduced travel time and costs, lower out-of-pocket expenses, improved access to specialist care in underserved areas, and increased patient satisfaction. It also helps neurologists save time, reduce missed appointments, and treat a more diverse patient population.
4. What are the challenges associated with teleneurology?
Challenges in teleneurology include high upfront costs for equipment, limited access to electronic health records during consultations, difficulties conducting comprehensive neurological exams remotely, and legality concerns related to licensing and prescribing medications across state lines. Reimbursement issues, especially with Medicare, also pose significant obstacles.
5. How is teleneurology utilized in modern healthcare?
Teleneurology is widely used for managing conditions like stroke, epilepsy, neurorehabilitation, pediatric neurology, outpatient consultations, mental health evaluations, and global neurology. It has become essential for addressing the shortage of neurologists and expanding access to specialized neurological care worldwide.
