In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Neurosurgery and Telemedicine: Assessment of the Opportunities and Risks

    Final Number:

    Elyne Kahn MD; Catherine A. Mazzola MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    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.

    References: 1. Telemedicine: opportunities and developments in Member States: report on the second global survey on eHealth. World Health Organization;2010. 2. Bauer JC. Rural America and the digital transformation of health care. New perspectives on the future. The Journal of legal medicine. Mar 2002;23(1):73-83. 3. State Coverage for Telehealth Services. Accessed March 4, 2015. 4. Blum JD. Internet medicine and the evolving legal status of the physician-patient relationship. The Journal of legal medicine. Dec 2003;24(4):413-455. 5. Providers and Professionals: Frequently Asked Questions: What is telehealth? How is telehealth different from telemedicine? Accessed December 14, 2014. 6. . Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. 7. Gilman M, Stensland J. Telehealth and Medicare: Payment Policy, Current Use, and Prospects for Growth. Medicare & Medicaid Research Review. 2013;3(4):E1-E14. 8. Heaton B. Experts Discuss 4 Major Barriers to Telehealth Adoption. Government Technology2014. 9. Lee B. Telemedicine's growing use may prompt lawsuits. Missouri Lawyers Media2009. 10. Wechsler LR. Advantages and Limitations of Teleneurology. JAMA neurology. Jan 12 2015. 11. Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. International journal of medical informatics. Nov 2010;79(11):736-771. 12. Oklahoma: The real power of telehealth: Building large networks. Plus Media Solutions: U.S. Official News2014. 13. McCormack M. Washington: How the VA is Blazing Trails in Telehealth: Meeting Patients Where They Live. Plus Media Solutions: U.S. Official News2013. 14. American Telemedicine Association: Corporate Members. - .VNKAT9Ao6M8. Accessed February 5, 2015. 15. Teladoc Secures $50 Million in Funding to Accelerate Explosive Growth, Solidify Market Leadership Position. India Investment News2014. 16. Hersh WR, Hickam DH, Severance SM, Dana TL, Krages KP, Helfand M. Telemedicine for the medicare population: update. Evidence report/technology assessment. Feb 2006(131):1-41. 17. Whitten PS, Mair FS, Haycox A, May CR, Williams TL, Hellmich S. Systematic review of cost effectiveness studies of telemedicine interventions. Bmj. Jun 15 2002;324(7351):1434-1437. 18. Balas EA, Jaffrey F, Kuperman GJ, et al. Electronic communication with patients. Evaluation of distance medicine technology. Jama. Jul 9 1997;278(2):152-159. 19. Kelly PJ. Neurological surgery at New York University Medical Center. Neurosurgery. Apr 1997;40(4):814-821. 20. Kelly PJ. Application of the World Wide Web to Neurosurgical Practice. Neurosurgery. 1997;41(4):995-996. 21. Moya M, Valdez J, Yonas H, Alverson DC. The impact of a telehealth web-based solution on neurosurgery triage and consultation. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. Nov 2010;16(9):945-949. 22. Duchesne JC, Kyle A, Simmons J, et al. Impact of telemedicine upon rural trauma care. The Journal of trauma. Jan 2008;64(1):92-97; discussion 97-98. 23. Bailes JE, Poole CC, Hutchison W, Maroon JC, Fukushima T. Utilization and cost savings of a wide-area computer network for neurosurgical consultation. Telemedicine journal : the official journal of the American Telemedicine Association. Summer 1997;3(2):135-139. 24. Angileri FF, Cardali S, Conti A, Raffa G, Tomasello F. Telemedicine-assisted treatment of patients with intracerebral hemorrhage. Neurosurgical focus. Apr 2012;32(4):E6. 25. Wong HT, Poon WS, Jacobs P, et al. The comparative impact of video consultation on emergency neurosurgical referrals. Neurosurgery. Sep 2006;59(3):607-613; discussion 607-613. 26. Meyer BC, Raman R, Hemmen T, et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. The Lancet. Neurology. Sep 2008;7(9):787-795. 27. Demaerschalk BM, Bobrow BJ, Raman R, et al. Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial. Stroke; a journal of cerebral circulation. Jun 2010;41(6):1251-1258. 28. Demaerschalk BM, Raman R, Ernstrom K, Meyer BC. Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. Apr 2012;18(3):230-237. 29. Davis LE, Coleman J, Harnar J, King MK. Teleneurology: successful delivery of chronic neurologic care to 354 patients living remotely in a rural state. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. May 2014;20(5):473-477. 30. Legislative Summary: Balanced Budget Act of 1997 Medicare and Medicaid Provisions. https:// Accessed December 20, 2014. 31. CMS expands telehealth coverage in 2014. 2014; Accessed December 14, 2014. 32. Sokol AJ, Molzen CJ. The changing standard of care in medicine. E-health, medical errors, and technology add new obstacles. The Journal of legal medicine. Dec 2002;23(4):449-490. 33. Greene J. Telehealth bill promotes more talk with providers about what's covered. Crain's Detroit Business2014. 34. Smith T. Virtual doctor will see you now. Richmond Times Dispatch2014. 35. Charest B. The latest in medical specialties - teletrauma - comes to NH. The Union Leader (Manchester, NH)2012. 36. Obsolete laws, regulations stifle advance of 'telehealth'. The Indianapolis Business Journal2013. 37. Telehealth stakeholders praise CMS proposals, think more can be done. 2014; Accessed December 14, 2014. 38. Ho C. A push to expand telemedicine. Washington Post. October 20, 2014, 2014. 39. Reps. Mike Thompson, Gregg Harper Introduce Bipartisan Legislation To Expand Telehealth Services. Plus Media Solutions: U.S. Official News2014. 40. Wicker & Cochran Introduce Telehealth Legislation. Plus Media Solutions: U.S. Official News2014. 41. Heaton B. 5 Telehealth Bills to Watch. Government Technology. May 20, 2014, 2014.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy