At the beginning of the COVID-19 pandemic, with the demand for telemedicine and safe medical exams skyrocketing, neurologists examined 23 essential practices that take place during most neurological examinations to determine if they could be conducted online. Out of those elements, only two were deemed challenging in a virtual setting – the cardiovascular portion and the ophthalmoscopic examination – which were only mentioned because the technology to conduct these evaluations virtually is not in widespread use, yet (more on that later).
Because the American Medical Association (AMA) has endorsed the use of telemedicine, believing it to be the future of healthcare, it is heavily involved in expanding telehealth policies and adoption. During a recent AMA Telehealth Immersion Program webinar, a segment of the AMA Recovery Plan for America’s Physicians, four key elements were explicitly explored in how they could be adapted for teleneurology. Clinical Case Study: Telehealth for Neurology identified the following essential practices that can be done in-person or online with maximum effectiveness.
- Initial evaluation - A visit starts before the physician even asks the first question. The patient’s demeanor, facial cues, anxiety level, and other signals would not be very different whether in person or virtually. Can the patient articulate their sentences, are they experiencing tremors, or do they have trouble focusing? These visual clues give insight into the final diagnosis.
- Assisted examination - There are many things a patient can use, sometimes unassisted, at home or in a doctor’s office to assist a virtual doctor. The physician can tell the remote patient how to examine specific parts of their body. They can ask them to use a scale for weight measurement or take a temperature, reporting results back through the screen.
- Functional testing - As there are no standard tests for a functional neurologic disorder, doctors usually rely on assessing existing symptoms and ruling out any neurological or other medical condition that could cause issues. These signs are also often evaluated by a neurologist and a psychiatrist together for a correct diagnosis, which can be done in person or virtually.
- Object movement – A decrease in movement or strength in the arms or legs can be a sign of a neurological condition. Observing if a patient can lift heavy items, push or pull against a chair or a wall, or how they stand and walk can help a teleneurologist determine overall motor function and balance.
Other exam elements conducted online
According to the AMA’s 2021 Telehealth Survey Report, 98% of neurologists use some form of telehealth. The majority of these visits were to provide follow-ups, improve care, and offer better medication management for existing patients suffering from dementia, epilepsy, multiple sclerosis, and other conditions. However, many also treated strokes, headaches, concussions, and traumatic brain and spinal cord injuries in emergent settings. In both situations, exam elements must be conducted and can be easily performed through virtual neurological consults.
- Asking questions - Listening to patients’ stories and asking questions is essential; however, virtual physicians with the same level of caring and communication skills that an in-person provider exhibits will get the same responses no matter the location.
- Medical history - Producing a complete picture of patient history and gathering medication lists and allergies are fundamental in any medical visit and easily accomplished in a virtual setting. It has even been suggested that some patients are more comfortable sharing information when they are not face-to-face.
- Physical exams – Teleneurology is most impactful when utilized in conjunction with a hospital or doctor’s office where assistance with physical exams can occur. A nurse or other provider can report the results of physical assessments to the virtual neurologist and administer further testing. This setup is especially beneficial in areas where neurologists aren’t readily available, which is an ongoing challenge for many communities.
The use of technology – now and in the future
Telemedicine finds ways to adapt to the demands of modern medicine, but other technological advancements can work in tandem with virtual healthcare to deliver better results. In addition to devices found in exam rooms, patients can utilize digital blood pressure cuffs, connected Bluetooth thermometers, and even their Apple Watch to deliver critical information to their virtual physician. With the FDA changing its medical device policy, more companies are inventing products to work specifically with telemedicine, making teleneurology evaluations even more comprehensive.
Better outcomes with teleneurology
Teleneurology delivers vital healthcare solutions to patients when the demand for neurologists is quickly increasing. The medical facilities modernizing their offerings by implementing a teleneurology program deliver better care and see more patients. VirtualMed Staff can help your hospital or specialist practice adopt a telemedicine program that is right for you. Contact us today to get started.
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