August 26, 2016

Neurology

Time-to-treatment is of the utmost importance. Telemedicine can make all the difference in terms of response time for patients located in rural areas.

  • Can intervene in an acute stroke before irreversible damage can occur – faster and more effectively than if the patient was flown by helicopter to an urban medical center.
  • Treatment of some conditions may require an initial exam, but the followup can be done by telemedicine.
  • Telemedicine provides other benefits: A patient suffering from Parkinson’s disease or Alzheimer’s disease who has to travel two hours to be evaluated might display very different symptoms than if they were seen ten minutes from their home. Care can now be extended to these patients with greater accuracy and effectiveness.

Interview with Allan L. Bernstein, M.D.

A practicing neurologist with a strong focus on clinical research, Dr. Allan Bernstein specializes in the areas of headache disorders and migraines, stroke, and Alzheimer’s disease, and conducts epidemiological research in the areas of Parkinson’s, multiple sclerosis, TIAs, and strokes. The former Chief of Neurology at the Kaiser-Permanente Medical Group in Santa Rosa, CA, he is currently working as a neurological consultant for OffSiteCare and was a consultant for Palm Drive Hospital in Sebastopol, CA. Known for his compelling presentations to international audiences and for his published body of work, Dr. Bernstein’s articles have appeared in the New England Journal of Medicine, the Lancet, the Annals of Internal Medicine, the Archives of Neurology, and other leading medical publications.

What type of neurological treatment is best-suited for telemedicine?

The area of neurology best-suited for telemedicine is acute stroke intervention. Time-to-treatment is of the utmost importance, and telemedicine can make all the difference in terms of response time for patients located in rural areas. The ability to provide successful interventions in acute stroke cases via telemedicine has been clearly documented, and that is a key part of the OffSiteCare program.

What other areas of neurological treatment can be addressed through telemedicine?

Treatment of movement disorders is different in terms of its relationship to telemedicine. Initial examinations and diagnosis are best made in person, and then ongoing care can be provided through remote telepresence. To treat movement disorders, I need to determine whether a tremor is rapid or slow, and whether it affects one side or both sides. Testing patients for cogwheel rigidity, lead-pipe stiffness, or loose muscles requires a hands-on exam. However, I don’t need a detailed exam every time I see a patient. Once the diagnosis is made I can follow my patients remotely.

Remote telepresence is also well-suited for treating headaches and epilepsy. Successful treatment of headaches is less dependent on physical exams than other neurological disorders. Telemedicine can be used effectively as a primary consultation for headache disorders, which require a very detailed verbal history and an analysis of their response to prior treatments. Treatment of epilepsy may require an initial exam, but the followup can be done by telemedicine. Epilepsy patients often need documented check-ins with a neurologist for driver’s license renewals and other certifications, and these can be handled via telemedicine. This reduces, or eliminates, the need to drive 100 miles for a 15-minute appointment with their physician.

How does telemedicine affect the delivery of neurological services to rural areas?

For the first time, telemedicine is providing access to neurological services in rural areas where traditionally there has been very limited access to providers. Of course, this is key for acute stroke intervention, but it goes beyond that. For older populations where mobility can be an issue, having local access to neurological care is significant. For example, a patient suffering from Parkinson’s disease that has to travel two hours to be evaluated might display very different symptoms than if they were seen ten minutes from their home. Care can now be extended to patients suffering from Parkinson’s disease, or Alzheimer’s disease with greater accuracy and effectiveness than before this technology was introduced.

How do you see telemedicine affecting your neurological practice in the future?

I would like to establish a telemedicine-based neurology clinic in Willits, which is located about 100 miles from my practice. It’s an underserved community, and this would eliminate travel time and enable the community to be supported by a neurological practice. This approach is ideal for cases where the ER doctor has gathered the patient’s history, ordered lab work and an MRI, tested for drug abuse, and provided initial medications. I could provide a remote consult on admits, referrals, or followups, and provide the neurologist’s perspective to pull it all together.

Moving treatment out of the acute ER setting and into a clinic delivers a wide range of benefits. The cost of healthcare could be lowered dramatically by a simple half-hour consult with a patient, especially one who frequently turns to the emergency room for treatment. ER care is expensive, and telemedicine offers a way to contain costs while actually improving the quality of care. Additionally, patient care can be managed over time by the local doctors, who can sit in and gain training on neurological issues. And expert consultants can be brought in to synthesize data, and use the telemedicine system to pick up additional information that might have been missed.

How long have you been with OffSiteCare, and how has your practice changed during that time?

I’ve been with OffSiteCare since 2008. During that time, I’ve become used to seeing a wide variety of patients remotely, ranging from seizures, metabolic encephalopathies, stroke, and trauma. The system works remarkably well, and it’s made my practice more manageable. The typical neurological practice has three physicians, which means you’re on call every third night and every third weekend. If it’s busy, by the third night of the weekend, you’re exhausted – this really causes burnout, and one of my colleagues actually fell asleep at the wheel of his car at 2AM on a Sunday night. Other physicians use small planes to service rural communities, but doctors are notorious for being bad pilots. Fortunately, my colleague wasn’t hurt, but the advantages of being able to see patients remotely via telemedicine cannot be overstated.

Working within the OffSiteCare network, I can cover five hospitals from a single site, either from my local hospital, or from my home. One of our hospitals is 200 miles away, and I can intervene in an acute stroke before irreversible damage can occur – faster and more effectively than if the patient was flown by helicopter to an urban medical center. It also enables me to provide ongoing care to a large number of people with chronic medical conditions, extend the reach of my practice, and effectively support patients in rural communities.