Introduction: Telemedicine--remote care of patients, aided by web-based or telephone-based telecommunications technology--has seen substantial growth in the twenty years, related to technological advancements and evolving reimbursement policies. At the national level, three bills are being considered in the U.S. Senate and House of Representatives that would further expand reimbursement opportunities for and reduce legal barriers to telemedicine. The risks and opportunities of neurosurgical telemedicine are nuanced.

Methods: We reviewed popular and peer-reviewed literature as it relates to telemedicine and neurosurgery, with particular attention to best practices, relevant state and federal policy conditions, economic evaluations, and prospective clinical studies.

Results: Despite technological development, growing interest and increasing reimbursement opportunities, telemedicine's utilization remains limited, due to concerns regarding an apparent lack of need for telemedicine services; lack of widespread reimbursement; lack of interstate licensure reciprocity; lack of universal access to necessary technology; concerns about maintaining patient confidentiality; and concerns and limited precedent regarding liability issues. The Veterans Administration represents a setting in which these concerns can be largely obviated and is a model for telemedicine best practices. Two randomized controlled trials have demonstrated that outcomes of telestroke care are comparable to standard stroke care, and prospective studies of neurosurgical "teletrauma" have demonstrated reduced costs and comparable clinical outcomes. Results from the VA demonstrate substantial cost savings and patient satisfaction with remote care for chronic neurological conditions. Overall, the economic and clinical benefits of telemedicine will likely come from (a) diminished travel times and lost work time for patients, (b) remote consultation of sub-specialty experts, such as neurosurgeons, and (c) remote consultation to assist with triage and care in time-sensitive scenarios, including acute stroke care and “teletrauma."

Conclusions: Telemedicine is effective in many healthcare scenarios and will become more relevant to neurosurgical patient care. We favor proceeding with legislation to reduce barriers to telemedicine’s growth.

Patient Care: Through a better understanding of telemedicine, neurosurgeons will be able to integrate the practice into patient care in a manner that provides safer and more effective, efficient, and patient-centered healthcare.

Learning Objectives: By the conclusion of this session, participants should be able to: (1) discuss the current policy conditions relevant to telemedicine, (2) describe the most important barriers to telemedicine, (3) discuss the telemedicine practices most relevant to neurosurgery.

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