Abstract
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. It is an important tool in improving the health and quality of life by using different ways of communication between neurologists and patients, or neurologists and other providers. We examine the current types of facilities available in tele-neurology, as well as outcomes, barriers, limitations, legal litigations, and the multidisciplinary nature based on prior studies. We have also suggested recommendations for the future of tele-neurology including effective-accessibility and inexpensive-utilization in developing countries.There are various tele-health programs created by The Veterans Health Administration including a clinical video tele-health (CVT) system. This system allows direct patient care of veterans by neurologists. The University of South Carolina implemented a web-based tele-stroke program in which acute ischemic stroke patients were treated in the Emergency Department (ED) of rural hospitals by neurologists, after consulting with rural ED physicians. With growing technology and popularity of tele-neurology, there are now international collaborative efforts in tele-medicine that are looking to be adapted to tele-neurology. Thus, tele-neurology can provide quality neurological care with patient satisfaction, as well as time and cost savings. The tele-stroke group established by TRUST-tPA trial (Therapeutic Trial Evaluating Efficacy of Telemedicine (TELESTROKE) of Patients With Acute Stroke) has 10 community hospital-emergency rooms that were connected to a stroke center. It was found that tele-stroke is appropriate in places where there is no way for a patient to access a stroke unit within a 4.5-hour time window. Like other tele-neurology subtypes, tele-epilepsy and pediatric tele-neurology also offer more follow-up care to people of remote areas which have limited access. There are other subtypes like mental health, chronic neurological care, and hospitalist which are very effective in improving outcome and quality of life of people living in remote areas. Tele-neurology has effectively reduced travel costs and times; there is high patient satisfaction and reduced disparity for general and specialized neurological care. But there are certain limitations like large equipment costs, certain bandwidth requirement, and trained staff to use the equipment. Transmission of patient information using public internet raises the concern of legality. There should be sufficient encryption to satisfy the Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure patient confidentiality and safety of personal data.The adaptation of tele-neurology is a powerful and innovative way to enhance healthcare in areas with a shortage of specialists. Implementation of this tool is limited due to cost burden, lack of expertise to implement necessary technology, legal litigations, and suitable financial and professional incentives for the users. This review focuses on the trajectory of utilization and the issues to be addressed in order to provide the full benefits of tele-neurology to undeserved communities in the future.
Highlights
Tele-neurology 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 which has been an important tool in improving the health and quality of life in those who are restricted to quality neurological care [1]
We have examined the current types of tele-neurology available, as well as prior research, outcomes, limitations, and the multidisciplinary nature of the relevant subtypes of tele-neurology including tele-stroke, tele-epilepsy, tele-radiology, pediatric tele-neurology, general tele-neurology, mental health, chronic neurological care, and tele-neurohospitalist work
Neurological disorders (Primary Care Physicians and Neurologists) stroke consults at Medical University of South Carolina (MUSC) from May 1, 2008, through April 6, 2016 alteplase administrations, number of patients transferred to MUSC, number of mechanical thrombectomies performed on transferred patients, the rate of symptomatic intracerebral hemorrhages, and discharge location
Summary
Tele-neurology 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 which has been an important tool in improving the health and quality of life in those who are restricted to quality neurological care [1]. Telemedicine implementations Benefits Increased practice outreach, development, and efficiency Decreased travel time and expenses for doctors and patients Expansion of educational opportunities and continuing medical education for physicians Individual and group education for patients about their neurologic disease Easy recruitment of patients into clinical trials Improvement of access to neurologic expertise for remote or underserviced areas Reduction in geographical disparity for neurologic care Decreased response time in stroke High patient and family satisfaction survey scores with their tele-neurology care Barriers Disruption of traditional doctor–patient relationship Physician reluctance to adopt novel technology in practice Limitations to billing and reimbursement for time spent Additional costs for technology Licensing, credentialing issues for out-of-state physicians Concern for malpractice liability Performing complete neurologic examination solely via telehealth, evaluating Obtaining neurodiagnostic tests such as EEG, EMG, and neuroimaging in remote settings. Is a brief review on previous studies related to tele-neurology (Table 3)
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