A 2019 review in Neurology cited several benefits of telemedicine, including:

  • Expediting care
  • Increasing access to care
  • Reducing cost
  • Improving health outcomes and diagnostic accuracy

The paper came out in December 2019, before most foresaw a drastic shift in healthcare – and increased need for telemedicine – brought on by the novel coronavirus pandemic.

At the recently held virtual fall meeting of the American Academy of Neurology, Dr. Scott Grossman, a neurologist in New York City, explained some of the challenges that he and his team have seen at NYU Langone Health in practicing neurology online.

“The limitations are significant,” said Grossman. “At present, they include the fundoscopic exam, which for me as a neuro-opthamologist is a major limitation. The cardiovascular exam and, of course, a targeted sensorimotor exam.”

There is also still little evidence to back up the effectiveness of performing these exams virtually.

“We have to have modesty about the evidence base for the general teleneurology exam because no currently validated comprehensive general neurology exam exists,” Grossman said.

There has been work on certain elements of the exam by different groups, but “no consensus exists that high-quality care for neurology patients can be achieved virtually. But the evidence base is growing.”

Other limitations to telemedicine include access: There are still some people unable to take advantage of a remote visit option.

“It is essential to mention that there will be unequal access to this new avenue of neurology care delivery,” Grossman said. It will depend “on technical prowess of individual patients, IT infrastructure in the home environment, and also patients who have variable issues with cognition, vision impairment, hearing impairment, and capacity to interface with technology.”

Some of these issues can be solved by using trained assistants in the home as well as family members.

“Necessity is the mother of invention,” said Dr. Grossman, who outlined his department’s quick adaptation to the more challenging aspects of the virtual neurology exam, including sensori-motor testing.

Despite these challenges, Grossman, like many, sees the positives outweighing the negatives. The “fundamental upsides,” he said, include insight into the home environment; the ability to reliably capture exam data across sites and upload it directly into the EMR; cost savings; and convenience for patients.

Optimizing the virtual visit will depend on us finding “a final resting place in which we feel comfortable doing the teleneurology exam, based either on past research or future research,” Grossman said. “The scales that we have were developed at a time when all of the neurology exam was done in person. That may be an important thing to investigate: Whether we need to develop a new set of scales for motor dysfunction to be used via the teleneurology connection.”



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