You might not think of neurology as a specialty that lends itself well to telehealth appointments, but the Veterans Health Administration and some academic medical centers have been operating teleneurology programs for the past few years. A study from the VA published in June about its program — thought to be the first of its kind for outpatients — found that the availability of teleneurology led to more timely care for rural residents. Veterans who received the service reported being highly satisfied to boot.
The program was launched in 2020 at 12 VA medical centers in rural locations (it has since expanded to 14 sites) in response to a growing mismatch between an aging population needing neurology care and a shortage of neurologists outside of major cities, said Linda S. Williams, M.D., senior author of the study and a clinician-researcher at the Department of Veterans Affairs and the nonprofit Regenstrief Institute in Indiana. Williams is also a professor of neurology at Indiana University School of Medicine.
Teleneurology has been used for a broad variety of conditions including migraine, movement disorders, and dementia, she said: “There’s a lot of the neurologic exam that you can do via video… by having patients film themselves walking or standing up from a chair.” Neurologists with the VA offer telehealth in two ways, she explained: either through a video visit conducted at the patient’s home or by having the patient go to a small, nearby outpatient clinic with a technician available to help with parts of the exam. There, the technician can use tools like a telehealth-linked stethoscope so the doctor can get more of a hands-on approach.
There are some techniques that can’t be done via telehealth at this time, Williams said, such as an electromyography (EMG), a procedure to assess the health of nerve and muscle cells. If such a test or an MRI or other type of scan is needed, the neurologist can refer the patient to a community neurologist. But the technology is improving all the time, she said. The VA is starting to contract with some companies that can visit a patient at home and place the electrodes for an electroencephalogram (EEG), a test to measure electrical activity in the brain and check for seizures. The results are recorded and sent digitally to the neurologist, who can read them from anywhere.
Some other medical centers offering teleneurology services include Massachusetts General Hospital in Boston, Vanderbilt University Medical Center in Nashville, and the University of Virginia in Charlottesville.
Teleneurology is one of numerous telehealth programs being offered by the VA’s Office of Rural Health. Others include teledermatology, telenephrology, telerehabilitation, sleep telemedicine for those with sleep apnea, teleaudiology and telediabetes services.
VA study findings
In the VA study published in the Journal of General Internal Medicine, 1,521 new patient consult orders were placed for neurologists by the 12 participating centers in 2020-2021, of which 1,084 (71%) were completed. These consults were scheduled within an average of 10 days and completed within an average of 44 days, compared with referrals to community neurologists, in which consults were scheduled within an average of 29 days and completed within an average of 96 days.
Among 540 veterans eligible to be called after their consults, 259 (48%) who completed phone interviews gave the service and their likelihood to recommend it a 6.3 average rating on a 1 to 7 scale. Referring providers also were highly satisfied; 146 providers surveyed highly rating the extent to which the consult addressed their question and the clarity of the neurologic plan, a mean of 9.0 on a 1 to 10 scale.
“We were interested to know if there were specific conditions that people had that made them more satisfied with teleneurology, like were people with a headache more satisfied than people with Parkinson’s disease … and we didn’t find any difference between the different neurologic conditions,” Williams said. “People who had a higher medical comorbidity (existence of more than one condition) were more satisfied with teleneurology care. … I suspect this is because it’s harder for them to get in [to see a specialist] and it may be more difficult to travel because of a functional disability, or just that they have lots of other medical care going on and it’s hard to juggle everything, so doing it in their home via video was actually a great satisfier for them.”
Journalists could find interesting stories by visiting one of the sites to see how teleneurology works, or by interviewing patients receiving services like these about what they like and how it fits in their activities of daily living, and talking to experts providing the services and referring providers about how it’s going for them.
“Sometimes there’s a mystique about neurology because we examine all these different parts of the nervous system, and people think it’s so in-depth, how could you ever do that via video,” Williams said. “I think it could be really interesting to illustrate how it can be done by video and the impact that it has on patients, especially patients who have had a stroke or brain injury, or epilepsy, and they can’t drive, and it’s difficult for them to get in to see a provider. I think that would be true and applicable to telehealth not just in the VA but anywhere.”
Another story idea from Williams: For veterans who don’t wish to conduct telehealth visits from home because of privacy concerns or have poor internet connectivity at home, the VA has established an initiative called ATLAS (Accessing Telehealth through Local Area Stations) – essentially, pods for telehealth located at some American Legion and Veterans of Foreign Wars halls and Walmart stores. The private spaces, big enough to accommodate wheelchairs and an extra caregiver or family member, contain computers that allow veterans to speak with their VA doctor(s) via a secure web link.