Lawrence Wechsler, MD, has spent the past decade working to overcome the myriad of barriers that prevented widespread adoption of teleneurology. He then watched the COVID-19 pandemic crush every one of them in mere weeks.
“Everything happened so quickly in the initial days of the pandemic,” says Dr. Wechsler, who joined Pennsylvania Hospital as Chair of Neurology in March. “There was little opportunity for formal training in teleneurology, let alone time to evaluate how the technology was working.” But as the dust began to settle, Dr. Wechsler made this a top priority.
“Our physicians completed surveys on each patient interaction to assess how well teleneurology worked,” he explains. “We received almost 1,700 responses and the analysis of the results is in progress.”
In general, Dr. Wechsler shares, his colleagues reported teleneurology was adequate for most clinical interactions and many see an important role for the technology in their practice. Some expressed deficiencies in the neurological examination, particularly specialists such as neuro-ophthalmologists who require specific equipment.
There were also some interesting experiences along the way.
“Everyone noticed that you get a different view of your patients when they’re at home,” Dr. Wechsler explains. “One patient picked up his guitar and played a song, another gave a tour of their art collection. This would never happen in a clinical setting. Teleneurology allows us to get to know our patients in a different way.”
Refining the Process
Dr. Wechsler shares that the next step in the evolution of teleneurology is to determine how to improve technology so it can be applied more broadly across neurologic conditions.
“We first need to identify which patients are appropriate for teleneurology and which should be seen in the office,” says Dr. Wechsler. “We’ll also assess the physical examination, patient-provider interaction, and workflow to determine where teleneurology fits into our practice.”
It’s a lot of work but worth the investment, indicates Dr. Wechsler. In an October 2020 editorial published in the Annals of Neurology, he shared that telemedicine supports a team approach to care by bringing providers together virtually and allowing family members to participate in visits. There’s also a benefit to patients in rural areas or those with limited mobility. In these cases, teleneurology streamlines evaluation and testing, potentially improving outcomes and reducing costs while increasing time efficiency for busy clinicians.
There is some uncertainty as to the future of telemedicine, however. According to Dr. Wechsler, the current reimbursement climate may change after the pandemic as insurers re-evaluate the appropriate indications and parity of payment for telemedicine. The familiarity and perceived advantages of telemedicine will hopefully translate into policy decisions to maintain this technology as an important component of care delivery.