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Neurology Talks Telemedicine

Lawrence Wechsler, MD, joined Penn Medicine in early March, just in time to witness historical changes to telemedicine.

Lawrence Wechsler, MD, the new Chair of Neurology at Pennsylvania Hospital, had been on the job for exactly two weeks when the first cases of COVID-19 appeared in Philadelphia. Just enough time to unpack his bags before setting to work doing what he loves — telemedicine.

Dr. Wechsler has spent much of the past 10 years developing and growing the Telestroke network and teleneurology team at University of Pittsburgh Medical Center. In fact, it was his commitment to this growing area of medicine, and the opportunity to direct the telemedicine program for Penn Medicine’s Department of Neurology, that ultimately brought him back to his alma mater in March. 

Now, here he was, lending his expertise to help rapidly expand the department’s existing telemedicine program at the height of a pandemic. The surreal aside, Dr. Wechsler recognized this was a defining moment for the technology-based approach to health care.

“Like every other department we were in a situation where we couldn’t see patients in person, so we had to find another way,” Dr. Wechsler says. “That other way was telemedicine.”   

At any other time, this may have been a straightforward process. But the need for telemedicine was not only immediate, it spanned the entire health system, presenting a unique set of challenges. 

“Penn had to quickly switch platforms (from video to BlueJeans), while clinicians had to simultaneously adjust to seeing patients remotely, and staff had to prepare patients for their visits—often teaching them how to use their smart phones, tablets or computer to communicate with us,” Dr. Wechsler explains. “But everyone rallied and we (Penn Medicine) quickly went from 50 telemedicine visits a day to 7,000.”

Putting Knowledge to Work

Within the department, the established Telestroke program provided a crucial launch point for Dr. Wechsler and his colleagues. 

“In neurology, telemedicine has already been embraced by many patients who have difficulty with travel or live far away—and those clinicians who have experience with it like it also,” says Dr, Wechsler. “But some neurologists believe that the physical exam, which involves feel and touch, can’t be done properly on a digital platform. We can gather a lot, however, from observation. And that information helps us make an accurate assessment of what’s going on with the patient.” 

To help prepare their patients for the transition, the department turned to its research coordinators.

“They called patients and walked them through the process of downloading or accessing the BlueJeans application,” Dr. Wechsler says. “They then performed a test visit so that patients were comfortable with the process and ready to go when the call from their doctor came. This saved a lot of time.”

In about 90 percent of cases, the virtual visits went off without a hitch, according to Dr. Wechsler. 

“Telemedicine can be a remarkable tool to deliver neurology care,” says Frances Jensen, MD, FACP, Professor and Chair, Department of Neurology, Penn Medicine. “We can provide more timely consults for patients in the convenience of their home at a time that works for them. This is a tremendous benefit for patients with chronic neurological conditions and they have overwhelmingly shared their appreciation for this convenience. 

“In fact, in April we actually saw more patients using telemedicine than we did pre-COVID,” she continues. “Though we realize of course that we need to see many patients in person and continue to bring our most urgent patients in house.”

Flipping the Script

Dr. Wechsler has grown used to barriers throughout his career. Reimbursement issues, licensing, credentialing, and physician attitudes have always stood in the way of making telemedicine an accepted approach to health care. Within two weeks, COVID-19 crushed every one of them.

“We don’t know what will happen once we’re through this pandemic,” he says. “I do suspect that insurers will try to walk things back. But the genie is out of the bottle. Now that people have experienced this, they don’t want to go back. I can easily see telemedicine comprising 50 percent of patient visits.”

It’s little wonder why people would feel this way, explains Dr. Wechsler. For much of the past century, medicine has operated under a provider-centric model. Patients get in the car, drive to the doctor’s office or hospital, park, sit in the waiting room and then, after the visit, do it all in reverse. It can take an entire day. Telemedicine, he says, flips the script and makes it much better for the consumer.  

“What we saw over the past two months is that we had fewer no-shows,” Dr. Wechsler says. “People kept their appointment because they were motivated. It was convenient, easier, and they didn’t have to spend half their day traveling.”

As for Penn Medicine, Dr. Wechsler thinks that telemedicine is here to stay—though not in its present form. Remote monitoring for blood pressure, weight and activity levels can be added to help accurately assess what is happening with patients. Other technologies can also be leveraged to improve the experience.  

For Dr. Wechsler, telemedicine is essentially the house call of the 21st century.

“My father was an internist and I remember him visiting patients in their homes,” he says. ““It provides a different perspective, and I think that’s where we’re heading.”

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