COVID-19: Launching Neurosurgery into the Era of Telehealth in the United States

Abstract

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Impact of COVID-19 on Neurosurgical Training in Southeast Asia

“…Many neurosurgical departments have shifted to telemedicine and virtual clinics. 30 , 31 Doctors must keep in mind that patients, especially from low-income and middle-income countries, may not necessarily have the gadgets or Internet connection to avail themselves of these services, leading to further delays in the provision of care.…”

Telemedicine in neurosurgery during SARS-CoV2 Pandemic

“…Starting from the medical difficulties, multiple studies considered lack of proper training for physicians in performing remote examination, which can result in poor or improper results. [3;9] Standarization and validation of the virtual tests, scales and examinations is needed as only a few centers undertook the effort to construct and conduct original remote examination [17] It was noted that the US National Institute of Health Stroke Scale can serve as the sufficient base for the neurooncology remote examination, however for skull base abnormalities the more detailed cranial nerves examination as well as specific, more detailed extremities examination depending on the preexisting pathology, are needed additionally to the main examination. [22] Blue et al described following limitations of telemedicine examination: difficulties in corneal reflex and visual fields assesment, neuromuscular pathologies: difficulties in examination of tone, rigidity, peripheral strength, subtle signs of Parkinson's disease -rigiditiy, retropulsion pull testing; impossible to perform HINTs exam for vestibular syndrome and Dix-Hallpike for cerebellar examination.…”

“…In the US example, with the declaration of the national public health emergency, the legislative changes-Coronavirus Preparedness and Response Supplemental Appropriations Act including the 1135 waiver authority, enabled American citizens to receive telehealth services in current circumstances, and waive or reduce the cost-sharing for those visits. [17][18][19] Three types of the telehealth services are considered: medicare telehealth visits for new and established patients, brief virtual check-ins to decide if in-person consultation is needed and e-visits through an online portal -both for previously established patients. [23] In study from Poland by Szmuda et al, the legislative changes regarding telemedicine changed on 11.03.2020 with a special decree of Ministry of Health which enabled the reimbursement of the telehealth visits held.…”

Letter to the Editor: “Telehealth and Telemedicine in the COVID-19 Era: A World of Opportunities for the Neurosurgeon”

“…Over time, applications continued to expand to include neurotrauma, epilepsy, Parkinson disease, stroke rehabilitation, and chronic pain, among others. 5 Despite these advances, the use of telemedicine in neurosurgery has been limited. Barriers have included an unclear or unidentified need for telemedicine services, medico-legal problems related to providers reimbursement, interstate licensing, lack of universal access to technology, patient confidentiality, and liability for negligence.…”

“…7 In the COVID-19 era, the main advantages offered by telemedicine for a patient are that it provides greater availability of health care for populations with inconveniences to receiving medical care, especially for specialized medical care such as neurosurgery; eliminates geographic barriers while adhering to COVID-19 safety guidelines; patients can avoid traveling (and being exposed to the virus); and reduces lost work due to hospital visits and reduces patient expenses. 1,2,5 Likewise, it allows patients to be adequately examined according to their symptomatology, along with their medical and surgical history, allowing them to be identified as potential candidates for surgical intervention or conservative treatment. 1 In this order of ideas, in the context of the current pandemic, the main objective of hospitals should be to reduce staff within the facilities to avoid exposure to the virus.…”