TECHNOLOGY IN NEUROLOGY
As people grow more accustomed to having access to almost everything at their fingertips, virtual medical care (ie, telemedicine) will be an increasingly sought-after service. In neurology, the most common use of telemedicine is in acute settings—such as evaluation for stroke in the emergency department, monitoring in the ICU, or consultations in other inpatient settings.
“Telemedicine is also being used to evaluate patients in nursing homes or remote sites, including rural areas in the United States and in remote locations in other countries to determine which patients need to be transferred to higher level care,” says Jaime Hatcher-Martin, MD, PhD, Assistant Professor of Neurology at Emory University School of Medicine in Atlanta, who uses telemedicine. “More recently, there has been a push to incorporate telemedicine into the care of patients with chronic neurologic conditions, such as dementia, Parkinson’s disease, and multiple sclerosis.”
If you are looking to incorporate telemedicine into your practice, what you’ll need depends on the types of patients you see and who will use the equipment. If you’re just starting out in practice and will only be doing telemedicine minimally, you don’t need a lot of expensive equipment. Dr. Martin started out with a laptop, basic webcam, and an Internet connection.
Many fancy telemedicine carts that offer all kinds of bells and whistles exist. “These are great if either a lot of providers will use the equipment or if the set-up needs to be mobile,” she says. “However, for most of us doing chronic outpatient care, the setup stays in one room so limited tools are adequate.”
You will also need conferencing software. “Obviously, you want something that is secure and HIPAA-compliant,” she says. “Some use freely available software. Others use software that is either inexpensive, or—as in my case—they use something their institution already had a license to use.”
Dr. Martin says no specific training is required, although various medical organizations offer training courses. “I started out testing the software with family members and then with some patients that I trusted,” she says. “You can even try comparing a telemedicine exam with an in-person exam (ie, have the patient in another room and do the virtual exam first, then verify your findings with an in-person exam).
The patient perspective
Telemedicine improves access to care for patients by reducing the need to travel for those who live remotely or have mobility limitations. Thus it offers both convenience and cost savings. “This allows patients access to the best specialized care,” Dr. Martin says.
Patients who pay out-of-pocket or who have insurance that pays for direct-to-consumer telemedicine may not even need to leave their home for a visit.
Recently, Dr. Martin was out of town when a patient needed to be seen urgently. “We were able to schedule a quick telemedicine visit, which allowed him to avoid going to an emergency room,” she says.
Besides living in an area where telemedicine is covered by insurance, patients also need to have some basic computer or smartphone knowledge and competency. “Patients who are seen at home need to have an Internet connection fast enough for an adequate audio/video feed. It’s hard to evaluate tremor or fine motor movements if the video feed is jumpy and delayed,” Dr. Martin says.
Editor’s note: Part 2 of this article will discuss the pros and cons of telemedicine in specific settings.