Many of the pandemic-related changes to telemedicine are likely here to stay, as we concluded in our last post thanks to the insights of four industry experts. They also emphasized that for telemedicine to be truly sustainable, people will have to improve the way they implement it.

For many physicians, the move to telemedicine has been – and still is – challenging. It has forced them to wear more hats than usual. In addition to doctoring, they are handling many tasks normally handled by in-office staff, medical assistants, and even IT professionals.

“The first five to seven minutes are spent being an unpaid IT consultant to ensure connectivity,” neurologist Laurence Kinsella told us. “You never know how that is going to go and sometimes you just have to switch and just go with an audio call.”

Neurologist Heidi Schwarz said telemedicine is “a lot more labor intensive for the docs as it’s structured right now, because we don’t have techs. It’s time consuming doing things like medication reconciliation and administering the patient-reported outcomes to the patient, getting the answers, and putting that in the chart.”

How can neurology practices solve these issues?

Nothing beats experience, so to help answer that question we talked to some neurologists who have been knee deep in telemedicine since well before the pandemic. Here are three pieces of practical advice from these teleneurology veterans, lightly edited for clarity.

1. Have someone other than the physician prepare the patient before their visit.

Dr. Elaine Jones: “I think the most important things are the logistics and thinking about that ahead of time. People haven’t done this. Explain to the patient how this kind of visit goes. Have the patient think about where they set up their camera or their computer so they have a little room to walk, so that you can see them.”

2. Have someone other than the physician initiate the visit.

Dr. Heidi Schwarz: “One of the levels of staffing that we’re going to need with this is someone who actually initiates the visit — making sure that the patient gets online and goes through all of this stuff before we get on.”

Dr. Jaime Hatcher-Martin: “Have somebody that can come in and call the patient ahead of time, make sure their bandwidth is OK, make sure their volume is OK. Something that is more streamlined or automated for that would go a long way. There are some vendors that offer the ability for patients to log on and check their connection ahead of time.”

3. Invest in better equipment

Jones: “It’s important to have a good camera. The camera on most computers or phones is not good. For patients who are hard of hearing, it’s often better if you use a microphone; patients can hear better and you can hear them better, especially Parkinson’s patients who speak very quietly.”

Hatcher-Martin: “One of the biggest things that would be ideal, and we’re starting to see this more at the state and federal level, is the infrastructure for high speed internet. It doesn’t take much from a hardware standpoint to be able to do a video visit, but if you have dial-up and don’t have the connection, it’s all for naught.”

It is going to take some time for practices to fully catch up with such a rapid adoption of telemedicine. Everyone, however, agrees that it is well worth it.

“We need to be very creative, especially in neurology,” says Jones. “With the shortage of live bodies [in neurology practices], we need to be able to embrace some of this technology to meet the needs of the patients and to improve patient care. We can be more efficient with ‘tele’, if we set it up right.”

Special thanks to the following neurologists for speaking with us:

  • Heidi Schwarz, MD, Professor of Clinical Neurology, University of Rochester Medical center, Rochester, NY. She specialises in headache medicine.
  • Laurence Kinsella, MD, neurologist at SSM Health Neuroscience Institute, St. Louis, MO. He is board certified in internal medicine and neurology and specializes in neuromuscular medicine, electromyography and autonomic disorders.
  • Jaime M. Hatcher-Martin, MD, PhD, is a movement disorders specialist working as a neurologist for SOC Telemed.
  • Elaine Jones, MD, a neurologist for SOC Telemed, providing specialist care in ER’s across the country.