Optimizing the Use Of Teleneurology During the COVID-19 Pandemic

The number of confirmed cases of coronavirus disease 2019 (COVID-19) has exceeded 1,500,000 cases globally¹ and is expected to increase over time, with no signs of the virus abating any time soon. Patients with neurological diseases, particularly those with prior cerebrovascular diseases and immunocompromised patients, are at higher risk of complications when infected by the virus.² Furthermore, recent studies from China and Italy report that approximately 36% of patients with COVID-19 exhibit neurological symptoms.³ Since the COVID-19 pandemic, and due to the high rate of healthcare provider infections as well as the risk of worse outcomes when patients with neurological diseases are infected, the use of telemedicine has expanded and optimized to continue to provide care to patients and minimize the risk of infection to both patients and healthcare providers.

One of the main uses for telemedicine in neurology is the use of teleneurology services in the hospital setting. Teleneurology involves remotely evaluating patients with neurological illnesses presenting to the emergency room in community hospitals that otherwise have no or part-time in-person neurology coverage.^4–7 Prior to the implementation of such programs, patients were often transferred to a tertiary medical center to be evaluated by a neurologist. Such patients are now being evaluated through teleneurology consults, and an expert opinion can be provided regarding potential treatments, whether the patient needs to be admitted locally, transferred to the tertiary center, or dischargd. Teleneurology is particularly essential during natural disasters and pandemics such as the COVID-19 pandemic, when minimizing human interactions and maximizing hospital bed availability is greatly needed.

The COVID-19 pandemic has quickly identified the need to expand the use of teleneurology services to the outpatient setting to shift face-to-face follow-up and in-person evaluations immediately to remote, virtual encounters. Such systems allow patients to communicate with their neurologists from home via smartphone or home computers. Expanding the use of teleneurology outpatient networks will allow neurologists to continue to provide outpatient care and monitoring for neurological patients while exercising social distancing. Chronic neurological monitoring for disorders such as stroke, demyelinating disease, headache, and epilepsy is largely cognitive and can be safely completed via telemedicine. Many electronic medical record systems have virtual encounter functions, but have historically been underutilized until an event such as a pandemic.

Finally, telemedicine can be applied in academic centers through virtual rounding, given the current need for social distancing to protect patients and providers. At the Medical University of South Carolina, we have switched to virtual rounding completely for our inpatient services using teleconferencing platforms. Medical record pre-rounding is completed remotely by all team members. In an effort to maintain a rich medical education experience for trainees, virtual “table rounds” and academic discussions are completed through the teleconferencing platform each morning prior to clinical rounds. Only one team member will be “in-house” to move the workstation on wheels and to perform neurological exams, while the remainder of the team will be virtually rounding through the teleconferencing platform.

Natural disasters and pandemics such as COVID-19 pose major challenges to our health system. In the recently published article by Dr. Thomas Lee,⁸ he very elegantly describes his colleagues’ responses to the way providers had to adapt in order to minimize the number of patients having to present physically for their outpatient appointments. He describes one of his colleague’s experiences of reviewing scheduled patients to decide which patients needed face-to-face care and which patients could be treated virtually. After doing this for a while, she made the comment, “Isn’t this the way it always ought to be?” Her comment eloquently summarizes how the future direction of the healthcare system should be. Moving forward from this life-altering pandemic, and after developing and implementing widespread virtual outpatient follow-up, we should strive to take care of our neurological patients virtually as much as possible. Once predominantly virtual, neurologists may even see an increase in follow-up appointments, given the number of neurological patients who are unable to drive or travel due to epilepsy, headache, or weakness and those who should be avoiding exposure to other patients such as immunocompromised multiple sclerosis patients. Using the current pandemic to our advantage by trying to optimize the use of telehealth services for each specialty can significantly aid in reducing the spread of COVID-19 and other illnesses while providing continuity of care for our neurological patients. For neurological patients, this may and likely should become the new standard.

Disclosure Statement

The authors report no conflicts of interest in this work.

Funding Information

No funding was received for this article.