Telemedicine for genetic and neurologic evaluation in the neonatal intensive care unit

Abstract

Objectives Evaluate whether telemedicine can be used to perform dysmorphology and neurologic examinations in the neonatal intensive care unit (NICU) by determining the examination accuracy, limitations, and optimized procedures. Study design Prospective evaluation of NICU patients referred for subspecialty consultation for dysmorphic features (n=10) or encephalopathy (n=10). A physician at bedside (bedside clinician) performed an in-person examination which was viewed in real-time by a remote physician (remote consultant). Standardized examinations were recorded and compared. Subsequently, a qualitative approach established technique adjustments and optimization procedures necessary to improve visualization. Results Telemedicine examinations identified 81 of 87 (93%) dysmorphology examination abnormalities and 37 of 39 (92%) neurologic examination abnormalities. Optimization of remote consultant visualization required an active bedside clinician assisting in camera and patient adjustments. Conclusions Telemedicine can be used to accurately perform many components of the dysmorphology or neurologic examinations in NICU patients, but physicians must be mindful of specific limitations.

Emergency Video Telemedicine Consultation for Newborn Resuscitations

“…Although this study did not specifically address the validity of video assessment, evidence suggests that with the appropriate telemedicine technologies, high levels of agreement between bedside and remote physicians can be achieved on multiple physical examination findings, including genetic and neurologic examinations. 14,15 Because of the poor reliability and audiovideo quality of the technology used in this study, Mayo Clinic has transitioned the emergency telemedicine platform for newborn resuscitations to a wired solution. Local teams now use a wired telemedicine cart that is equipped with a high-definition camera with pan/tilt/zoom capabilities that can be remotely controlled by the neonatologist.…”

Clinical models of telehealth in genetics: A regional telegenetics landscape

“…When examining the literature specific to genetics consultation via live videoconferencing, the term “telegenetics,” is most often used, but the terms “virtual health” (Weissman, Zellmer, Gill, & Wham, 2018), “televideo” (Voils et al, ), and web‐based/video (National Society of Genetic Counselors, ) were also noted. Collectively, these studies have demonstrated improved access to care in underserved areas with high levels of patient satisfaction and outcomes similar to in‐person consultations across many patient populations and medical indications (Abrams & Geier, ; Bradbury et al, ; Buchanan et al, ; Coelho, Arnold, Nayler, Tischkowitz, & MacKay, ; D'Agincourt‐Canning et al, ; Fournier, Bazzell, & Dains, ; Gattas, MacMillan, Meinecke, Loane, & Wootton, ; Gray et al, ; Hardy & Grinzaid, ; Hawkins, Creighton, Ho, McManus, & Hayden, ; Hilgart et al, ; Hopper, Buckman, & Edwards, ; Kubendran, Sivamurthy, & Schaefer, ; Lea et al, ; Mette et al, ; Otten, Birnie, Lucassen, Ranchor, & van Langen, ; Schwartz et al, ; Solomons, Lamb, Lucas, McDonald, & Miesfeldt, ; Stalker et al, ; Sutphen et al, ; Weissman et al, ; Wenger et al, ; Zilliacus et al, ; Zilliacus, Meiser, Lobb, Kirk, et al, ). Some studies have shown reductions in cost and time per patient for the clinic and/or the patient (Buchanan et al, ; D'Agincourt‐Canning et al, ; Otten, Birnie, Ranchor, & van Langen, ; Schwartz et al, ; Weissman et al, ), shorter wait times (Cohen et al, ; Kubendran et al, ; Stalker et al, ; Weissman et al, ), and a larger geographic reach (Cohen et al, ).…”

“…access, genetic counseling, genetic services, rural, service delivery, telegenetics, telehealth, telemedicine, telephone counseling, underserved Fournier, Bazzell, & Dains, 2018;Gattas, MacMillan, Meinecke, Loane, & Wootton, 2001;Gray et al, 2000;Hardy & Grinzaid, 2017;Hawkins, Creighton, Ho, McManus, & Hayden, 2013;Hilgart et al, 2012;Hopper, Buckman, & Edwards, 2011;Kubendran, Sivamurthy, & Schaefer, 2017;Lea et al, 2005;Mette et al, 2016;Otten, Birnie, Lucassen, Ranchor, & van Langen, 2016;Schwartz et al, 2014;Solomons, Lamb, Lucas, McDonald, & Miesfeldt, 2018;Stalker et al, 2006;Sutphen et al, 2010;Weissman et al, 2018;Wenger et al, 2014;Zilliacus et al, 2011;Zilliacus, Meiser, Lobb, Kirk, et al, 2010). Some studies have shown reductions in cost and time per patient for the clinic and/or the patient (Buchanan et al, 2015;D'Agincourt-Canning et al, 2008;Otten, Birnie, Ranchor, & van Langen, 2016;Schwartz et al, 2014;Weissman et al, 2018), shorter wait times (Cohen et al, 2013;Kubendran et al, 2017;Stalker et al, 2006;Weissman et al, 2018), and a larger geographic reach (Cohen et al, 2013).…”

Speech and language screening for children with medical complexity: A comparison of telepractice and in-person methods

“…This may improve efficiency and save costs for the service provider (32 Telepractice also offers the opportunity for local SLPs to access educational and mentoring opportunities (131,(138)(139)(140). Telemedicine studies have reported improved communication between local doctors and paediatric subspecialists (138,139,141), with subsequent improvements in the quality and continuity of care (138,139,(141)(142)(143)(144)(145). It is likely that similar effects would occur for speech pathology patients.…”

“…Telepractice has been well-established as an effective way to deliver tertiary-level medical and nursing services to CMC (131,141,144,(162)(163)(164)(165)(166)(167)(168)(169)(170). However, there is limited evidence to support telepractice for speech pathology management of complex paediatric patients.…”