Teleneurology: Is it really at a distance?

Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Journal of Neurology (Impact Factor: 3.38). 02/2011; 258(6):971-81. DOI: 10.1007/s00415-011-5920-5
Source: PubMed


Telemedicine refers to the transfer of medical information from one site to another using distance communications technology. This approach has benefitted many medical specialties, with telestroke being a prelude to its applications in neurology. Our review will focus on the use of telemedicine in neurological practice (teleneurology) following a brief discussion of telestroke. Given the emerging nature of trial evidence in teleneurology, our aim is to provide a narrative review and highlight areas that merit further investigation.

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    • "Because mobile devices can deliver streaming video and audio, they can be used to evaluate acute stroke patients remotely.18 Comparison between the face-to-face method and the mobile telemedicine method of assessment using the National Institutes of Health Stroke Scale (NIHSS) showed high inter-method agreement according to the correlations in total NIHSS scores between the methods (r=0.94 to 0.98, P<0.001) and an acceptable length of remote assessment time (3.38 to 11.4 minutes).15 "
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    ABSTRACT: Information technology and mobile devices may be beneficial and useful in many aspects of stroke management, including recognition of stroke, transport and triage of patients, emergent stroke evaluation at the hospital, and rehabilitation. In this review, we address the contributions of information technology and mobile health to stroke management. Rapid detection and triage are essential for effective thrombolytic treatment. Awareness of stroke warning signs and responses to stroke could be enhanced by using mobile applications. Furthermore, prehospital assessment and notification could be streamlined for use in telemedicine and teleradiology. A mobile telemedicine system for assessing the National Institutes of Health Stroke Scale scores has shown higher correlation and fast assessment comparing with face-to-face method. Because the benefits of thrombolytic treatment are time-dependent, treatment should be initiated as quickly as possible. In-hospital communication between multidisciplinary team members can be enhanced using information technology. A computerized in-hospital alert system using computerized physician-order entry was shown to be effective in reducing the time intervals from hospital arrival to medical evaluations and thrombolytic treatment. Mobile devices can also be used as supplementary tools for neurologic examination and clinical decision-making. In post-stroke rehabilitation, virtual reality and telerehabilitation are helpful. Mobile applications might be useful for public awareness, lifestyle modification, and education/training of healthcare professionals. Information technology and mobile health are useful tools for management of stroke patients from the acute period to rehabilitation. Further improvement of technology will change and enhance stroke prevention and treatment.
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    ABSTRACT: To determine the current practice and plans for telemedicine at leading US neurology departments. An electronic survey was sent to department chairs, administrators, or faculty involved in telemedicine at 47 neurology departments representing the top 50 hospitals as ranked by U.S. News and World Report. Current use, size, scope, reimbursement, and perceived quality of telemedicine services. A total of 32 individuals from 30 departments responded (64% response rate). The primary respondents were neurology faculty (66%) and department chairs (22%). Of the responding departments, 60% (18 of 30) currently provide telemedicine and most (n = 12) had initiated services within the last 2 years. Two thirds of those not providing telemedicine plan to do so within a year. Departments provide services to patients in state, out of state, and internationally, but only 6 departments had more than 50 consultations in the last year. The principal applications were stroke (n = 14), movement disorders (n = 4), and neurocritical care (n = 3). Most departments (n = 12) received external funding for telemedicine services, but few departments (n = 3) received payment from insurers (eg, Medicare, Medicaid). Reimbursement (n = 21) was the most frequently identified barrier to implementing telemedicine services. The majority of respondents (n = 20) find telemedicine to be equivalent to in-person care. Over 85% of leading US neurology departments currently use or plan to implement telemedicine within the next year. Addressing reimbursement may allow for its broader application.
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