Beyond Audio-Video Telehealth: Perspective on the Current State and Future Directions of Digital Neurological Care in the United States (Preprint)

Abstract

BACKGROUND The COVID-19 pandemic transformed neurological care by both requiring digital health modalities to reach patients and removing or profoundly altering barriers to digital health adoption. This combination of factors has given rise to a distinctive, “new digital normal” care model in neurology. As the pandemic transitions to an endemic, there is a need to characterize the current and future states of this unique period in neurology. OBJECTIVE We sought to describe the current state of the “new digital normal” in neurology and offer a view of the possible future directions of the field. METHODS We reviewed several themes across the “new digital normal” in neurology, including trends in technology adoption, barriers to technology access, newly available telehealth services, unresolved questions, and an outlook on the future of digital neurology. RESULTS In the “new digital normal”, we emphasize that synchronous video telehealth remains the predominant form of digital interaction between neurologists and patients, mainly due to pandemic-related regulatory changes and pre-existing, steady adoption of video platforms in the pre-pandemic era. We also identify a persistent digital divide, making audio-only telehealth remains a necessity for preserving care access. Asynchronous telehealth methods and services, including care coordination, interprofessional consultations, remote patient monitoring, and teletreatment are becoming increasingly important for neurological care. Finally, we identify several unanswered questions regarding the future of this “new normal”, including the lasting effects of emergency regulatory changes, the value proposition of telehealth, the future of telehealth reimbursement in neurology, as well as privacy considerations and tradeoffs in asynchronous neurological care models. CONCLUSIONS The COVID-19 pandemic has ushered in an era of digital adoption and innovation in neurological care, characterized by novel care models, services, and technologies, as well as numerous unresolved questions regarding the future