Justin C. McArthur, MBBS, MPH
President, American Neurological Association, Director, Johns Hopkins Department of Neurology
The COVID-19 pandemic has disrupted lives on a global scale and forced innumerable changes in the delivery of healthcare, which have occurred on a very compressed timeline with significant improvisation and creativity. Telemedicine holds the promise of being able to increase access to healthcare for patients in underserved areas.
Before the pandemic, many institutions struggled with the logistical and regulatory barriers of deploying telemedicine. The COVID-19 crisis empowered the Centers for Medicare & Medicaid Services to relax rules over the use of and reimbursement for telemedicine services for Medicare recipients (formerly only covered for patients in rural areas).
Following the pandemic, enacting either a national licensing practice or removing state-to-state practice barriers is necessary. Enabling permanent changes at the federal and state levels will allow neurologists to better care for an increasingly aging population efficiently, conveniently, and safely, both during and after the COVID-19 crisis.
The value of telemedicine
Using telemedicine, I’ve given a new diagnosis of MS to several patients and treated new onset seizures and concussions. Creative solutions have been developed to allow clinicians to perform many parts of the neurological examination. While telemedicine can substitute for many ambulatory visits, of course it is no replacement for emergency care in the case of serious injury, heart attack, or stroke.
For patients with neurological disorders that affect mobility — for example, stroke, Parkinson’s disease, and neuromuscular disorders — telemedicine represents an opportunity for in-home visits and avoids the need for burdensome and potentially unnecessary travel to a distant clinic. An added advantage of a telemedicine visit is that the neurologist can see the home environment and conduct a survey of potential safety issues.
We need to ensure ALL of our patients can receive the neurological care they need, whether in person or via telemedicine. Bridging the ‘digital divide’ will require significant investment in broadband access both in rural and low-income urban areas.
The next generation of teleneurology may actually be employed through the use of kiosks placed in pharmacies or retail spaces. Other platforms include devices equipped with BP cuffs, high-resolution cameras, and even retinal photography.
Beyond COVID
Even before COVID-19, telemedicine had been shown to be a feasible strategy for the remote recruitment, enrollment, treatment, and evaluation of patients with neurological disorders. Safety monitoring can be integrated into telemedicine platforms in a relatively straightforward manner. Telemedicine also holds the promise to reduce access barriers to neurological clinical trials for people of color who have not enrolled in research proportionate to demographics.
Telemedicine isn’t without its challenges, but the ability to continue to provide care and conduct clinical research remotely means all patients who need care can continue to receive it in a safe and convenient manner.
Overall, we are seeing remarkable progress in the fields of neurology and neuroscience, and there are even more breakthrough treatments and technologies on the horizon.