Download PDF
Semin Neurol 2022; 42(01): 012-017
DOI: 10.1055/s-0041-1742195
Review Article

Telehealth for Comprehensive Care of Acute Neurologic Disorders

Marcelo Matiello
1   Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
,
Adam B. Cohen
2   Department of Neurology, Yale New Haven Health System, Yale Medical School, New Haven, Connecticut
3   National Health Mission Area, The Johns Hopkins Applied Physics Lab, Laurel, Maryland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

A teleneurology hospitalist model aims to address the demand for high-quality neurologic acute care and the shortage of neurologists. Here, we review concepts and models of teleneurology services to address access and care gaps in neurology beyond telestroke models. The goal of these emergent teleservices is to empower community hospitals to deliver the highest quality care, while also reducing unnecessary patient transfers to tertiary care hospitals. We highlight the clinical models, patient populations, and innovative approaches of different tele-neurohospitalist services. This includes challenges related to clinical limitations, legal issues, and reimbursement. We highlight specific areas of research that can further clarify and refine the appropriate use, cost-effectiveness, and clinical outcomes of these telemedicine-based care models.

Keywords

telemedicine - telehealth - teleneurology - neurohospitalist


Publication History

Article published online:
16 May 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Dall TM, Storm MV, Chakrabarti R. et al. Supply and demand analysis of the current and future US neurology workforce. Neurology 2013; 81 (05) 470-478
    CrossrefPubMedGoogle Scholar
  • 2 Freeman WD, Vatz KA, Griggs RC, Pedley T. The Workforce Task Force report: clinical implications for neurology. Neurology 2013; 81 (05) 479-486
    CrossrefPubMedGoogle Scholar
  • 3 Douglas MR, Peake D, Sturman SG, Sivaguru A, Clarke CE, Nicholl DJ. The inpatient neurology consultation service: value and cost. Clin Med (Lond) 2011; 11 (03) 215-217
    CrossrefPubMedGoogle Scholar
  • 4 Fuller GN. Improving liaison neurology services. Pract Neurol 2020; 20 (06) 494-498
    CrossrefPubMedGoogle Scholar
  • 5 Anand P, Klein JP. Inpatient consultations in neurology. Semin Neurol 2021; 41 (05) 475-476
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Josephson SA, Douglas VC. Hospitalist neurology. Semin Neurol 2015; 35 (06) 609
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Porter ME. What is value in health care?. N Engl J Med 2010; 363 (26) 2477-2481
    CrossrefPubMedGoogle Scholar
  • 8 Arkwright B, Leslie M, Light M. Telehealth Finance Variables and Successful Business Models. Telehealth and Medicine Today; 2019
    Google Scholar
  • 9 Dorsey ER, Topol EJ. State of telehealth. N Engl J Med 2016; 375 (02) 154-161
    CrossrefPubMedGoogle Scholar
  • 10 Mutgi SA, Zha AM, Behrouz R. Emerging subspecialties in neurology: telestroke and teleneurology. Neurology 2015; 84 (22) e191-e193
    CrossrefPubMedGoogle Scholar
  • 11 Craig JJ, McConville JP, Patterson VH, Wootton R. Neurological examination is possible using telemedicine. J Telemed Telecare 1999; 5 (03) 177-181
    CrossrefPubMedGoogle Scholar
  • 12 Patterson VH, Craig JJ, Wootton R. Effective diagnosis of spinal cord compression using telemedicine. Br J Neurosurg 2000; 14 (06) 552-554
    CrossrefPubMedGoogle Scholar
  • 13 Craig J, Chua R, Russell C, Patterson V, Wootton R. The cost-effectiveness of teleneurology consultations for patients admitted to hospitals without neurologists on site. 1: a retrospective comparison of the case-mix and management at two rural hospitals. J Telemed Telecare 2000; 6 (Suppl. 01) S46-S49
    CrossrefPubMedGoogle Scholar
  • 14 Craig J, Chua R, Russell C, Wootton R, Chant D, Patterson V. A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients. J Neurol Neurosurg Psychiatry 2004; 75 (07) 1031-1035
    CrossrefPubMedGoogle Scholar
  • 15 Wechsler LR, Demaerschalk BM, Schwamm LH. et al; American Heart Association Stroke Council, Council on Epidemiology and Prevention, Council on Quality of Care and Outcomes Research. Telemedicine quality and outcomes in stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2017; 48 (01) e3-e25
    CrossrefPubMedGoogle Scholar
  • 16 Canto-Torán E, Vivas-Consuelo D, Barrachina-Martinez I, Escudero-Torrella J. Hospital processes and costs in neurology. A study of a referral hospital. [in Spanish]. Rev Neurol 2011; 53 (10) 599-606
    PubMedGoogle Scholar
  • 17 Hatcher-Martin JM, Busis NA, Cohen BH. et al. American Academy of Neurology Telehealth Position Statement. Neurology 2021; 97 (07) 334-339
    CrossrefPubMedGoogle Scholar
  • 18 Singh R, Ng WH, Lee KE, Wang E, Ng I, Lee WL. Telemedicine in emergency neurological service provision in Singapore: using technology to overcome limitations. Telemed J E Health 2009; 15 (06) 560-565
    CrossrefPubMedGoogle Scholar
  • 19 Rincon F, Vibbert M, Childs V. et al. Implementation of a model of robotic tele-presence (RTP) in the neuro-ICU: effect on critical care nursing team satisfaction. Neurocrit Care 2012; 17 (01) 97-101
    CrossrefPubMedGoogle Scholar
  • 20 Craig J, Patterson V, Russell C, Wootton R. Interactive videoconsultation is a feasible method for neurological in-patient assessment. Eur J Neurol 2000; 7 (06) 699-702
    CrossrefPubMedGoogle Scholar
  • 21 Chua R, Craig J, Wootton R, Patterson V. Cost implications of outpatient teleneurology. J Telemed Telecare 2001; 7 (Suppl. 01) 62-64
    CrossrefPubMedGoogle Scholar
  • 22 George BP, Scoglio NJ, Reminick JI. et al. Telemedicine in leading US neurology departments. Neurohospitalist 2012; 2 (04) 123-128
    CrossrefPubMedGoogle Scholar
  • 23 Matiello M, Turner AC, Estrada J. et al. Teleneurology-enabled determination of death by neurologic criteria after cardiac arrest or severe neurologic injury. Neurology 2021; 96 (15) e1999-e2005
    CrossrefPubMedGoogle Scholar
  • 24 Akbik F, Hirsch JA, Chandra RV. et al. Telestroke-the promise and the challenge. Part one: growth and current practice. J Neurointerv Surg 2017; 9 (04) 357-360
    CrossrefPubMedGoogle Scholar
  • 25 Akbik F, Hirsch JA, Chandra RV. et al. Telestroke-the promise and the challenge. Part two-expansion and horizons. J Neurointerv Surg 2017; 9 (04) 361-365
    CrossrefPubMedGoogle Scholar
  • 26 Boes CJ, Leep Hunderfund AN, Martinez-Thompson JM. et al. Primer on the in-home teleneurologic examination: a COVID-19 pandemic imperative. Neurol Clin Pract 2021; 11 (02) e157-e164
    CrossrefPubMedGoogle Scholar
  • 27 Espay AJ, Aybek S, Carson A, Edwards MJ. wt al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol 2018; 75 (09) 1132-1141
    CrossrefPubMedGoogle Scholar
  • 28 Cohen AB, Nahed BV. The digital neurologic examination. Digit Biomark 2021; 5 (01) 114-126
    CrossrefPubMedGoogle Scholar
  • 29 Bragin I, Cohen DT. Certified examination assistants in the age of telemedicine: a blueprint through neurology. JMIR Med Educ 2021; 7 (04) e28335
    CrossrefPubMedGoogle Scholar
  • 30 McCormick R, Estrada J, Whitney C. et al. Teleneurology comprehensive inpatient consultations expedite access to care and decreases hospital length of stay. Neurohospitalist 2021; 11 (03) 229-234
    CrossrefPubMedGoogle Scholar
  • 31 Baker-Whitcomb A, Harvey J. Benefits and barriers to telehealth credentialing by proxy. Telemed J E Health 2018; 24 (11) 922-926
    CrossrefPubMedGoogle Scholar
  • 32 Tarolli CG, Biernot JM, Creigh PD. et al. Practicing in a pandemic: a clinician's guide to remote neurologic care. Neurol Clin Pract 2021; 11 (02) e179-e188
    CrossrefPubMedGoogle Scholar
  • 33 Roy B, Nowak RJ, Roda R. et al. Teleneurology during the COVID-19 pandemic: a step forward in modernizing medical care. J Neurol Sci 2020; 414: 116930
    CrossrefPubMedGoogle Scholar
  • 34 Shachar C, Engel J, Elwyn G. Implications for telehealth in a postpandemic future: regulatory and privacy issues. JAMA 2020; 323 (23) 2375-2376
    CrossrefPubMedGoogle Scholar
  • 35 Zha AM, Chung LS, Song SS, Majersik JJ, Jagolino-Cole AL. Training in neurology: adoption of resident teleneurology training in the wake of COVID-19: telemedicine crash course. Neurology 2020; 95 (09) 404-407
    CrossrefPubMedGoogle Scholar
  • 36 Govindarajan R, Anderson ER, Hesselbrock RR. et al. Developing an outline for teleneurology curriculum: AAN Telemedicine Work Group recommendations. Neurology 2017; 89 (09) 951-959
    CrossrefPubMedGoogle Scholar
  • 37 LeRouge C, Wilson KD, Sterling R, Trocchio J. Viewing telehealth through the lens of a community benefit mission. Telemed J E Health 2017; 23 (08) 662-673
    CrossrefPubMedGoogle Scholar
  • 38 Cohen AB, Dorsey ER, Mathews SC, Bates DW, Safavi K. A digital health industry cohort across the health continuum. NPJ Digit Med 2020; 3 (01) 68
    CrossrefPubMedGoogle Scholar
  • 39 Demaerschalk BM, Berg J, Chong BW. et al. American Telemedicine Association: telestroke guidelines. Telemed J E Health 2017; 23 (05) 376-389
    CrossrefPubMedGoogle Scholar
  • 40 Ahmed SN, Mann C, Sinclair DB. et al. Feasibility of epilepsy follow-up care through telemedicine: a pilot study on the patient's perspective. Epilepsia 2008; 49 (04) 573-585
    CrossrefPubMedGoogle Scholar
  • 41 Vitacca M, Comini L, Tentorio M. et al. A pilot trial of telemedicine-assisted, integrated care for patients with advanced amyotrophic lateral sclerosis and their caregivers. J Telemed Telecare 2010; 16 (02) 83-88
    CrossrefPubMedGoogle Scholar
  • 42 Davis LE, Coleman J, Harnar J, King MK. Teleneurology: successful delivery of chronic neurologic care to 354 patients living remotely in a rural state. Telemed J E Health 2014; 20 (05) 473-477
    CrossrefPubMedGoogle Scholar
  • 43 Wechsler LR. Advantages and limitations of teleneurology. JAMA Neurol 2015; 72 (03) 349-354
    CrossrefPubMedGoogle Scholar
  • 44 Cohen AB, Mathews SC. The digital outcome measure. Digit Biomark 2018; 2 (03) 94-105
    CrossrefPubMedGoogle Scholar