Practicing in a Pandemic

Abstract

Neurologists around the country and the world are rapidly transitioning from traditional in-person visits to remote neurologic care because of the corona virus disease 2019 pandemic. Given calls and mandates for social distancing, most clinics have shuttered or are only conducting urgent and emergent visits. As a result, many neurologists are turning to teleneurology with real-time remote video-based visits with patients, to provide ongoing care. Although telemedicine utilization and comfort has grown for many acute and ambulatory neurologic conditions in the past decade, remote visits and workflows remain foreign to many patients and neurologists. Here, we provide a practical framework for clinicians to orient themselves to the remote neurologic assessment, offering suggestions for clinician and patient preparation prior to the visit; recommendations to manage common challenges with remote neurologic care; modifications to the neurologic exam for remote performance, including subspecialty-specific considerations for a variety of neurologic conditions; and a discussion of the key limitations of remote visits. These recommendations are intended to serve as a guide for immediate implementation as neurologists transition to remote care. These will be relevant not only for practice today, but also for the likely sustained expansion of teleneurology following the pandemic.

Healthcare Professionals’ Experience of Performing Digital Care Visits—A Scoping Review

“…The urgency of the situation sped up the process of authorization and regulation regarding legal matters such as new payment models for remote health care services and health information privacy [ 19 ]. Digital care visits got implemented in various areas of health care—primary care, mental health [ 20 , 21 ], orthopedic care [ 22 ], neurology [ 18 , 23 , 24 ], palliative care [ 25 ], pharmacy [ 26 ], dentistry [ 27 ], and others. Even though digital care visits do not provide possibilities for physical examinations where a healthcare professional would need to examine a patient physically, video consultations allow specialists to evaluate and sometimes diagnose by inspecting the patient through video.…”

Movement Disorders Virtual Fellowship Training in Times of Coronavirus Disease 2019: A Single-Center Experience

“…The notion that a subspecialty such as movement disorders neurology relies heavily on an in-person physical examination is being challenged by external public health circumstances and as new tools are developed to facilitate remote examination not only in movement disorders but also in general neurology. 9 Our department has been able to adapt, in part, thanks to the external support provided by the IT department, the current EPIC Ò electronic medical record (EMR) platform, and the policy changes after the state of emergency, the visits were transitioned to other video platforms (such as the Doximity video call application, or Zoom); therefore our experience can be reproduced elsewhere despite not having EPIC as the EMR or the PolyCom RealPresence Web Suite. Another limitation to our ability to generalize from this study is that the overall access to cell phones with cameras, laptops, and broadband internet connection on the patients' end in other areas of the country and the world is more limited compared with our population.…”

“…The main methods used to assess pertinent parts of the physical examination have been described recently in the literature. 9 For patients with a DBS implanted, remote interrogation was limited and relied on the patient extracting information from his/her own patient programmer.…”

Telehealth for Comprehensive Care of Acute Neurologic Disorders

“…The coronavirus disease 2019 (COVID-19) pandemic required health care systems to radically and rapidly rethink the delivery of care and that has been closely associated with the possibility of expansion of tele-neurohospitalist services. 32 33 The pandemic also provided the incentive and familiarity needed to realize the potential of telehealth. One of the most significant changes has been payment parity; without payment, it would be difficult for clinicians in any specialty to provide the service.…”