Incorporating Telemedicine into Neurology Practice

Telemedicine comes with a bevy of regulatory hurdles, but research presented at the 43^rd Annual Child Neurology Society Meeting suggests the concept has the potential to create clinical efficiencies without sacrificing care.

Paul Lipkin, MD, of the Kennedy Krieger Institute and Johns Hopkins University, outlined the regulatory landscape and some of the latest telemedicine research in an Oct. 23 presentation.

Telemedicine licensure is state-based, meaning physicians who wish to “see” patients in more than one state will need to be licensed and/or registered in each state, with a handful of exceptions. Those exceptions include telemedicine consultations done for educational or training purposes, physician-to-physician consultations, and medical emergencies.

At the federal level, the US Food and Drug Administration has oversight over telemedicine devices and software used for the diagnosis or treatment of conditions. The FDA’s Center for Devices and Radiological Health is in charge or pre-market review, quality standards and other science-related issues.

Lipkin noted that payment for telemedicine services also presents a challenge, because the 50 states vary in the degree to which insurers accept telemedicine services. Seventeen states and the District of Columbia have both Medicaid coverage and private insurance coverage for telemedicine services. Another 26 states have only Medicaid coverage of telemedicine.

Setting aside the regulatory challenges, Lipkin presented the findings of a number of studies looking at the efficacy of telemedicine in clinical settings.

A 2012 survey of faculty and chairs at 30 neurological departments found 60% offered telemedicine services, mostly in emergency department, and mostly related to stroke. Nearly two-thirds, 63% said the care they provided was equivalent to the care they could have provided in person.

A 2014 survey of Veterans Affairs Administration patients in a rural US state found 90% patient satisfaction, and savings of more than $48,000.

Other research has shown telemedicine to be beneficial in the rapid neurological evaluation of patients in remote areas. For instance, Parkinsons patients who were given “virtual” house calls” showed no difference in quality of life measures versus those receiving in-person care.

Applications for children include using video clips to screen children with movement disorders and using videoconferencing to assess Autism symptoms.

A 2013 Autism study found parents were satisfied and reliability was maintained when in-person evaluations were replaced with video conferences.

Other challenges facing physicians who use telemedicine include patient privacy concerns, malpractice liability questions, and the cost of hardware and software. Still, early research suggests physicians and patients could benefit from wider deployment of the technology.