“Telehealth is not the future—it’s the present. If you aren’t using it now, you will be soon,” says neurologist Eric Anderson, MD, PhD, who practices telemedicine in more than 20 states and 80 hospitals in the U.S. Telestroke is the most ubiquitous example of telemedicine in use today, but catching up quickly are virtual office visits and patient monitoring via wearable technology and mobile phone apps.
The American Telemedicine Association, which keeps up with these trends, reports that telemedicine is already a multi-billion-dollar industry.
“Right now, stroke is the biggest driver of telemedicine,” says Anderson. This has a lot to do with the fact that reimbursement for these services is the biggest limiting factor. “Telestroke is used by hospitals that don’t have a neurologist (in remote areas, for example).” These facilities can be reimbursed for neuro services if they qualify as a “stroke consult.”
On-demand medical services like Teladoc, which offer medical consults by web, phone or mobile app evade the reimbursement issue altogether by charging a membership fee. Services can be purchased by individuals or by businesses. Teladoc also partners with some health insurance companies.
Another example is the company 23andMe, which the FDA now says can inform clients if they are at risk for certain diseases. This goes for ten diseases currently, three of which are neuro related: Parkinson’s, late-onset Alzheimer’s, and early onset dystonia.
Anderson urges neurologists not to limit their thinking to how they will get paid. “Think about what you can do with [telemedicine], not just what you will be reimbursed for.” This kind of forward thinking leads to innovation. “There are so many possibilities, and you want to be on the development edge of this, not just reacting to it.”
Telemedicine could provide tremendous benefits for neurology patients. Especially since they can be some of the most immobile of all patients. Anderson gives the example of a child with cerebral palsy in a power chair who lives miles away from your office.
People already have computers and mobile phones and increasingly they expect that they can use their devices to get the care needed. “[We are] moving out of episodic care into a continuous care model.” Normally you give a patient a new drug and you see them three weeks later. Now mobile apps help you monitor patients. You get feedback sooner, so you can treat sooner.
Most of this monitoring technology is still just used reactively. “It’s not sophisticated enough to be proactive, but it is moving in that direction,” says Anderson. The problem too is that doctors don’t have time to sift through all the potential data that can be collected in real time. He sees a future where there will be a team approach combining IT with healthcare… “Someone managing the data and incorporating it into the care of patients.”
Telehealth also has the potential to fill in the gaps created by an aging population and the shortage of neurologists in this country. According to this 2017 study published in Neurology, when patients had to wait more than 21 days for an appointment, they were almost seven times more likely to end up in the emergency room.
The authors of this Neurology editorial suggest that telehealth models can improve access to care and reduce the need for these emergency room visits, especially for patient with chronic conditions. “While reimbursement for telehealth remains a barrier to the widespread use of this care model, the growth of this technology is undeniable and will surely enable more people to receive needed care.”