Teleneurology Expansion in Response to the COVID-19 Outbreak at a Tertiary Health System in New York City

Abstract

ObjectiveTo assess the implementation of teleneurology (TN), including patient and clinician experiences, during the coronavirus respiratory disease 2019 (COVID19) pandemic.MethodsWe studied synchronous (video visit) and asynchronous (store-and-forward, patient-portal evaluation, remote monitoring) TN utilization in the Mount Sinai Health System Neurology Department in New York, 2 months before and after the start of our department's response to the pandemic in mid-March 2020. Weekly division meetings enabled ongoing assessments and analysis of barriers and facilitators according to the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change models. We used post-visit surveys of clinicians (from April 13 to May 15, 2020) and patients (from May 11 to 15, 2020) to determine technology platforms used, and TN experience and acceptability, using Likert scales (1 = very poor/unlikely to 5 = very good/likely).ResultsOver the 4-month period, 117 TN clinicians (n = 14 subspecialties) conducted 4,225 TN visits with 3,717 patients (52 pre-vs 4,173 post-COVID19). No asynchronous TN services were delivered. Post-COVID19, the number of TN clinicians, subspecialties performing TN, and visits increased by 963%, 133%, and 7,925%, respectively. Mean acceptability among patients and clinicians was 4.7 (SD 0.6) and 3.4 (SD 1.6), respectively. Most video visits were completed using Epic MyChart (78.5%), and Zoom (8.1%). TN implementation facilitators included Medicare geographic restriction waivers, development of clinician educational materials, and MyChart outreach programs for patients experiencing technical difficulties.ConclusionsA significant expansion of TN utilization accompanied the COVID19 response. Patients found TN more acceptable than did clinicians. Proactive application of an implementation framework facilitated rapid and effective TN expansion.

Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System

“…However, the digital divide may not be the sole explanation for our results, particularly among Medicaid beneficiaries. At our institution, a diverse population of Medicaid-insured patients are treated in hospital-administered clinics by resident and fellow trainees under the supervision of attending neurologists (2). Because many trainees were deployed to inpatient services for COVID-related care during the first several months of the COVID surge (2) and only returned to in-person office visits in June 2020, Medicaid-insured patients were likely unable to find available providers during the initial 3 months of the COVID pandemic between March and May 2020.…”

“…This time interval was defined as the "pre-COVID period, " with March 16 th , 2020 marking the beginning of our Department's administrative procedures to mitigate virus transmission risk in the setting of the emerging public health threat related to the pandemic and the issued shelter-in-place order in New York State. These procedures consisted of converting scheduled in-person visits to video TN visits or deferral of care and have been described elsewhere (2).…”

“…In the first and second quarters of 2020, the global public health emergency caused by the novel coronavirus (coronavirus disease 2019 or COVID-19) promoted widespread adoption of telemedicine and teleneurology (TN) as patients and providers sought to minimize virus transmission and preserve access to neurological care worldwide (1)(2)(3)(4)(5)(6). Building on the limited uptake of both telemedicine and TN preceding the COVID-19 pandemic, (7,8) the COVID-19 crisis saw rapid increases in acceptance among neurologists for TN, which firmly established the latter as a viable care model in neurological populations (9).…”

Pitfalls in the Diagnosis of Posterior Circulation Stroke in the Emergency Setting

“…Hence, there has been growing need for efforts to improve remote evaluation and management of patients with neurologic complaints. The use and acceptance of teleneurological consultations have been increasing (125,126), and it is encouraging that observable neurological signs, which are feasible for remote assessment, appear to have better inter-rater reliability than elicitable signs, which often require direct contact with the patient (127). Since virtual HINTS and the Dix-Hallpike maneuver have been demonstrated to be applicable via telemedicine (110), solutions for additional components of the oculomotor exam may be developed and implemented.…”

Service Process Factors Affecting Patients’ and Clinicians’ Experiences on Rapid Teleconsultation Implementation in Out-patient Neurology Services during COVID-19 Pandemic: A Scoping Review

“…The six identified key service process factors and themes among clinicians and patientsThe rst key service process factor, technical issues, was raised mainly by clinicians who reported signi cant gaps in this area, especially regarding functionality, reliability, availability, accessibility, system exibility, technical support, and training [26,47,47,49,[53][54][55]. For instance, clinicians indicated that patients' technological capacity was a barrier to successful teleconsultation[26,55].…”