Outcomes of Teleneurology Implementation During the COVID-19 Pandemic

Teleneurology services have expanded significantly during the COVID-19 pandemic, and patients generally reported positive experiences with these services. Providers initially reported a less favorable experience, but this improved later during the implementation, according to study results published in Neurology Clinical Practice.

The objective of the current study was to determine the outcomes of the expansion of teleneurology in response to the COVID-19 pandemic at a tertiary health system in New York City, including synchronous (video visit) and asynchronous (store-and-forward, patient-portal evaluation, remote monitoring) teleneurology services.

Using data from Mount Sinai Health System’s neurology department in New York, collected for 2 months before and after the start of the department’s response to COVID-19 pandemic, study researchers assessed teleneurology utilization. Post-visit surveys of clinicians and patients were used to assess the experience and acceptability of the platforms used.

Study researchers identified a total of 117 teleneurology clinicians (in 14 subspecialties), who conducted 4225 unique teleneurology visits (52 pre-COVID-19 and 4173 during COVID-19) with 3717 patients. They did not identify any asynchronous teleneurology services during the study period.

From the first to the second period, the total number of clinicians conducting teleneurology visits increased by 963%, the number of subspecialties providing teleneurology services increased by 133%, and the total number of teleneurology visits increased by 7925%. Most video visits were completed using Epic MyChart (78.5%), and Zoom (8.1%).

Patients generally reported high acceptability of synchronous teleneurology. The mean overall acceptability score (with 1 being lowest to 5 being highest) was 4.7. The lowest individual experience rating was 4.4 for the ease of logging into the teleneurology visit, followed by 4.5 for the clarity of visit login instructions.

The numerical rating of clinicians about the likelihood of recommending teleneurology to colleagues was 3.4 on a scale to 1 to 5 (with 1 being very unlikely to 5 being very likely), although ratings improved to 4.1 when clinician experience was assessed at the end of the study.

The study had several limitations, including lack of data about the reasons for which patients or providers chose to use teleneurology over telephone visits or deferral of care, the exclusion of telephone visits from the definition of teleneurology, the use of anonymous survey data for patient and clinician experience with potential response bias, and a lack of long-term data on the effects of teleneurology.

“A significant expansion of [teleneurology (TN)] utilization accompanied the [COVID-19] response. Patients found TN more acceptable than did clinicians. Proactive application of an implementation framework facilitated rapid and effective TN expansion,” concluded the study researchers.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Kummer B, Sweetnam C, Vickrey BG, et al. Teleneurology expansion in response to the COVID-19 outbreak at a tertiary health system in New York City. Neurol Clin Pract.. Published online March 9, 2021. doi:10.1212/CPJ.0000000000001057