Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores

Thakar, Sumit; Rajagopal, Niranjana; Mani, Subramaniyan; Shyam, Maya; Aryan, Saritha; Rao, Arun S; Srinivasa, Rakshith; Mohan, Dilip; Hegde, Alangar S.

doi:10.3171/2018.2.focus17543

Cited by 52 publications

(58 citation statements)

References 26 publications

(24 reference statements)

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“…These visits have been replaced by telemedicine clinic visits, which have previously been validated in the neurosurgery population. [5][6][7][8][9] We have implemented Health Insurance Portability and Accountability Act (HIPPA)-compliant telehealth technology integrated into our electronic medical record (Epic, Epic Systems Corporation, Verona, Wisconsin). Neurosurgeons and their patients can communicate via secure video-conference feed using a computer, mobile device, or tablet.…”

Section: Clinic Schedulingmentioning

confidence: 99%

Letter: Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model

Eichberg¹,

Shah²,

Luther³

et al. 2020

Neurosurg.

139

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Section: Clinic Schedulingmentioning

confidence: 99%

Letter: Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model

Eichberg¹,

Shah²,

Luther³

et al. 2020

Neurosurg.

139

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“…34 Notably, another study found that any potential reduction in efficacy may be offset by the cost-effectiveness and utilitarian benefits of telemedicine. 35 The cognitive demand imposed on users by different video conference platforms may be a key consideration in selecting the appropriate platform. Agnisarman et al 36 compared the usability of 4 platforms-Doxy.me, Vidyo, VSee, and Polycom-with a sample clinical scenario that included a log-in sequence, changing to full screen, muting the microphone, disabling video, communicating over chat, and concluding the session.…”

Section: Considerations In the Implementation Of Telehealthmentioning

confidence: 99%

Telemedicine in the Era of Coronavirus Disease 2019 (COVID-19): A Neurosurgical Perspective

et al. 2020

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*Deep tendon, plantar, Babinski reflexes if tele-examiner present Limitations of the telemedicine neurologic examination Comprehensive eye examination Cannot assess corneal reflex May be difficult to assess visual fields Neuromuscular examination Reflex testing may not be possible Difficult to fully assess peripheral strength and grade subtle strength differences between sides of the body Limited assessment of tone and rigidity May be hard to detect subtle signs of Parkinson's disease: in particular rigidity and retropulsion pull testing 44 Vestibular examination Cannot perform HINTs exam (Head Impulse, Nystagmus, Test-of-skew) for vestibular syndrome Cerebellar examination Cannot perform Dix-Hallpike test for cerebellar infarction FDA, Food and Drug Administration. *Elements of the examination that may be more difficult to perform.

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“…Teleconsultation for daily routine, including its implementation for neurosurgical cases, is already practiced in many countries such as Norway, 3 United Kingdom, 7,8 USA, 9 Germany, 2,10 and India. 11 The advantages of this technology seem particularly convincing in rural areas. Nevertheless, the role of German neurosurgeons in teleconsultation is not yet clear.…”

Section: Experience With Teleconsultationmentioning

confidence: 99%

Current Practice of Neurosurgical Teleconsultation in Germany

Geiger

Wilhelmy

Schmidt

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objective As neurosurgery is a demanding specialty with services in larger medical centers only, consultation over larger distances plays an important role in health care. In times of digitalization, teleconsultation for medical images and cases plays an increasing role in neurosurgical services. However, no standards and demands have been established for its execution in the subfield of neurosurgery, so far. Therefore, as a first step, we performed a survey about the current state of teleconsultation in neurosurgery in Germany. Methods A standardized questionnaire consisting of 20 items was used to investigate the frequency of use and the operating conditions of teleconsultation in the field of neurosurgery. The survey was performed during the annual national German Society of Neurosurgery conference in 2017. Participation in the written survey was on voluntary and anonymous basis. Results In total, 296 individuals took part in the survey (140 specialists in neurosurgery, 77 residents). Among them, 71% were male and 121 worked at a university medical center. In total, 87.5% of all participants indicated that teleconsultation was used in their institutions (n = 113 in university medical centers and n = 76 in hospitals), and a vast majority stated to have had personal experience with it (88.6% of specialists, 85.5% of residents). The most frequent initial request for a consultation was done by phone call (80.3%). Images or data were then primarily transmitted via an electronic system (77.3%), followed by transmissions via CD or by post. The reply to a consultation was also mainly done by phone call (91.3%), followed by fax, or by e-mail. No standard protocol was followed by 78.6% of the respondents, and they stated not to know about the statutory and legal rules. However, it was stated that the protection of patient data was not endangered by using teleconsultation. The usefulness of teleconsultation and its future relevance were rated highly by the participants. The risk of misinterpretation of image data, especially without having direct access to other patient data, seemed to be a critical and unequivocal challenge. Conclusion The results of the survey demonstrate that teleconsultation for medical images and cases is a frequently used and well-accepted tool in neurosurgical health care. However, a standardized neurosurgical procedure is still lacking and the statutory rules for this field of digital medicine are generally not known in our community. Potential misinterpretation and resulting misjudgment seem to be realistic drawbacks. Thus, we see a necessity for elaboration of guidelines for teleconsultation in neurosurgery on national and European basis.

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Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores

Cited by 52 publications

References 26 publications

Letter: Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model

Letter: Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model

Telemedicine in the Era of Coronavirus Disease 2019 (COVID-19): A Neurosurgical Perspective

Current Practice of Neurosurgical Teleconsultation in Germany

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