Neurologists from Vanderbilt University Medical Center published a study of their 13-month experience with an inpatient teleneurology program. Of 976 consultations at six hospitals, 13% of patients were transferred and 87% stayed at their local hospital. The most common diagnosis was stroke, followed by seizure and headache. Of patients surveyed, 92% said that the care provided through the teleneurology program was satisfactory or excellent. The average time between the order for the teleconsultation and the teleconsultation was 6 minutes.
Ochsner instituted a temporary program that allowed its neurologists to perform rounds remotely at another hospital. Calls for rounds arrived during the afternoon, and each neurologist was scheduled to perform rounds for two hours during the following morning. Physicians at the remote hospital would roll a cart from room to room, and Ochsner’s neurologists saw as many as four patients during rounds. The average amount of time with each patient was 24 minutes, and the neurologist also spent time documenting the consultation afterwards. Ochsner plans to revisit the program this year, said Dr. Houghton.
The Challenges of Teleneurology
Teleneurology can improve response times and the efficiency of care, but it also poses several challenges. For example, the approach disrupts the traditional doctor–patient relationship, and some health care providers consequently are reluctant to adopt it. A teleneurology program will fail if physicians are forced to accept it, said Dr. Houghton. It is better to convince neurologists of the program’s potential benefits before instituting it, he added.
Perhaps the biggest concern that teleneurology entails is the limitation that it imposes on the neurologist’s ability to perform a detailed neurologic exam, said Dr. Houghton. Teleneurology also could hinder the transmission and interpretation of clinical data. The communication system must be capable of transmitting tests such as EEGs clearly. “With data, it’s garbage in, garbage out, so you have to make sure that there’s not garbage in,” said Dr. Houghton.
In addition, billing and reimbursement can be limited in a teleneurology program. Many contracts, however, include retention fees that cover expenses and protect providers’ time. A teleneurology program also entails high startup costs because of equipment that must be purchased.
Licensing also can pose difficult questions, particularly if a neurologist will be seeing patients in more than one state. In addition to requiring a license to practice medicine, many states require a telemedicine license. In some states, a telemedicine license does not permit a neurologist to interpret radiographic images; these states require the neurologist to have a traditional medical license.
Randomized controlled trials are needed for a complete assessment of the care provided through teleneurology, he continued. To take full advantage of teleneurology, hospitals should collaborate and form larger partnership networks. International collaborations also could be beneficial, although they may raise questions about licensure and liability. Finally, teleneurology should be reimbursed at the same rate as traditional, in-person care, Dr. Houghton concluded.
—Erik Greb