Teleneurology is the use of real-time or delayed communication between neurologists and patients, or neurologists and other providers by way of shared audio, video, secure messaging, and other data exchanges. Teleneurology has been an important tool in improving the health and quality of life in those who are restricted to quality neurological care. These restrictions to care are often due to geographic isolation. There are certain areas that lack a neurologist or patients must travel long distances to receive care. Tele-neurology has provided an outlet in which patients and physicians, although at great distances apart, are able to communicate and be examined within an instant. 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 a backdrop of 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. Considering the fact that neurological conditions have large mortality and disability rates, there is a need for innovative services like tele-neurology. The adaptation of tele-neurology is a powerful and innovative way to enhance healthcare in areas with a shortage of specialists. Tele-neurology has the potential to reduce healthcare costs, hospitalization services, and improve multidisciplinary communication between different providers regarding the care for their patients.
As detailed above, there are numerous times in which tele-neurology has a positive impact. Exorbitant 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 costs savings with telehealth utilization. There are also reduced travel costs and travel times associated with tele-neurology, as well as high patient satisfaction, reduced geographical disparity for general and specialized neurological care, and more educational opportunities for physicians available.
Challenges for Teleneurology
For all the benefits of tele-neurology, there are some issues and limitations as well.
- There are large upfront costs for equipment and telecommunication lines required for synchronous tele-neurology; the equipment must be operated by trained staff, and sufficient connection bandwidth is required and even then, some technology only allows one person to speak at each time.
- Additionally, many times the doctor does not have access to the electronic health record of the patient they are consulting. Some imaging and tests are also not available remotely, and the ability to conduct the neurological exam is often limited. Thus, many tele-neurology practices only see a follow-up, rather than new, patients.
- Asynchronous technology, although inexpensive and convenient for high-volume and triage work, does not allow for the neurologist to personally take a history or see the exam conducted.
- Additionally, both synchronous and asynchronous tele-neurology has been viewed as promoting a shift within neurology from securing a final diagnosis to more 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.’
- There are also legality concerns associated with tele-neurology. Since transmissions traverse the public Internet, there should be sufficient encryption to satisfy HIPAA requirements and to ensure patient confidentiality and the safety of personal data. WhatsApp’s encryption, for instance, is not compliant and 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 are often unable to prescribe medication or order tests by telemedicine.
- Reimbursement is also frequently cited as a great challenge to telemedicine; Medicare reimbursement is often difficult and requires certain service locations and appropriate sites to provide the healthcare, and many insurers only reimburse for in-person services.
The utilization of tele-neurology 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 era of a global shortage of neurologists and other healthcare providers. Patients receive the benefits of time-saving and reduced travel expenses. A physician also saves time, gets exposed to a more diverse patient population, and has fewer missed appointments and cancellations. Though some experts believe that tele-neurology has its limitations, overall, it is an effective tool to bring a new horizon in modern neurological care.
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