Telemedicine itself is medicine conducted at a distance. Consultations are not done in person. Diagnoses are done remotely. The concept is not very new. It dates to about 1969. What has changed is that technology allows diagnoses to be conducted over a telephone or via a web cam. These forms of technology allow the boundaries of space and time to fall away, making it faster for doctors to diagnose patients and for patients to access those diagnoses with a speed not known prior to the development of telemedicine.
Many medical specialties make use of telemedicine. Radiologists, pathologists and dermatologists have used telemedicine for a while mostly because of the need for visual reports and patient imaging. Telepsychiatry has begun to flourish. Patients are able to communicate with less apprehension when they can conduct a session with their doctor via the Internet. Teleneurology has begun developing in a widespread manner in recent years.
Potential Uses For Teleneurology Services
Teleneurology is divided into care that is clinician initiated or patient initiated. Either party can take advantage of telemedicine which is the same as telecare or telehealthcare in that it is a technology allowing an instantaneous, private dialog between doctors and patients. The term is somewhat arbitrary as doctors and patients are capable of being characterized as denizens of Marshall McLuhan’s “Global Health Village.” That term has yet to be used in a popular way for this form of care.
Neurology benefits from using telecare because patients who are located in remote or rural areas can now access doctor care from doctors based in major metropolitan areas. Remote patients may have trouble accessing this technology, but the fact that it is growing is proof that soon even very remote patients will have access to this critical form of urgent care.
In some consultations, a medical specialist works to assess the patient in person. This occurs while another medical professional, usually the neurologist, is observing this from a remote location via a video link. The consultations are appropriately documented. With technical support, the teleneurology consultation process diagnoses the patient and a treatment plan is devised.
These teleconsultations can make hospital stays shorter. Patients sometimes worry about privacy, but generally it is the doctor’s or hospital’s duty to ensure no breach of privacy occurs, which is the case with ordinary medical records. A clear advantage of these consultations is a reduction in travel for both doctor and patient. With less travel, there is less of a carbon footprint made on our planet.
Additionally, it is more feasible for family members to attend the teleconsultation. This is good for patient support and for accuracy in obtaining patient family history. Expertise from professionals is brought to individuals in areas that are physically poorly served by neurology professionals.
There are two links used in telemedicine. One is the synchronous links or real-time consultations. The other is “store and forward” links or asynchronous links. E-mails are asynchronous links as they store the information obtained in a consultation and forward it to the proper neurologist. This can save a lot of time for patients and doctors. The UK’s Data Protection Act governs confidentiality in e-mail consultations.
Hospitals and doctors must adhere to good practices when it comes to e-mail. It is necessary to ensure all e-mails are copied to all parties involved. They must also be included in hospital notes and records. If various treatments are involved in a consultation the notes regarding these treatments must also be comprehensive and stored properly for access later.
The General Medical Council in the UK has issued guidelines for remote prescriptions and hospitals must insure they have a tight computer infrastructure, with secure data backup. The UK General Medical Council has issued guidelines on this as well as remote prescriptions and maintaining electronic contact information.
The Wave Of The Future — Teleeducation
Education and training benefit from the dissemination of medical knowledge through tele-modules like websites and video conferences. Students and doctors alike can take classes or continue education using teleeducation. Patients themselves can participate in grand rounds of videoconferences. Some educational programs or events can be videoconferenced to students from afar.
Google is expected to begin assisting neurologists and students with its neurology search results. Its efficacy depends mostly on the user’s ability to conduct a neurological online search and interpret all accessed search results.
Benefits of Teleneurology For Consumers
Self-care for consumers is expected to grow as they are increasingly able to access information online pertaining to treatments of various health conditions. The quality will depend on the information available through online searches. The information must be completely accurate or a consumer could misdiagnose themselves and treat themselves in an adverse manner. This can be avoided if the telemedicine field creates a standard for accurate Internet information for patient care.
Even without telemedicine technology in play, patients today often present information to their doctors about their health concerns. Much of the information is obviously gleaned from Internet searches. Often, these searches result in inaccurate information about the patients issues.
Many neurologists are familiar with a patient’s family member relaying the latest studies done for an epileptic loved one. They want the doctor to let their loved one try some new and unproven medication, which the neurologist knows does not even truly exist. The Internet has misled the family member who is concerned about the future of their loved one. There are other occasions where patients bring new health reports to their appointments scared that they have all the symptoms of some new and strange disease. It seems that too much of the wrong information can create more hypochondriac behavior than it can an accurate and helpful patient-led diagnosis or treatment.
While it is hoped that teleneurology will develop into a widely used service by consumers, it is obvious that much needs to be done to ensure that patient care is done within the realm of neurologist-led teleconsultations and that any patient-accessible information online is accurate.
Neurological Disorders Capable Of Being Handled With Telemedicine
Headaches are some of the most accurately self-diagnosed neurological concerns. Teleneurology will make it faster and easier to consult with a professional for suggested treatments or further recommendations for diagnosis. Today, patients can still access NHD Direct telephone help lines to get information about their headaches. Much of the information there has been derived from algorithms, which makes a personal diagnosis and treatment plan rather inadequate. Teleneurology shows more promise.
For patients, current Internet websites offer a lot of information about various types of headaches and their treatments. Still, some information is biased which is a concern. A good teleconference with a qualified medical specialist seems a much better option for the headache sufferer.
Dementia can be assessed using telephone interviews to conduct cognitive measurements. Teleconferences with a patient’s family members present can be even more helpful. They can allow the neurologist to assess the patient’s level of dementia all while offering helpful information to the family member for a course of treatment or therapy.
Tests like the Structured Telephone Interview for Dementia Assessment are easy to use to diagnose the condition whether over the telephone or over a video link.
Alzheimer’s patients are better off using one-on-one care with the help of teleneurology. These patients may not be able to access or understand accessed websites as it is. However, their caregivers can do this yet it seems these individuals can get much-needed support via teleconferencing or video conferencing. The number of caregivers to Alzheimer’s patients is growing and this means that accurate information on care is essential. In the first two years of its service, the Counselling and Diagnosis in Dementia telephone service noted that over 50 percent of callers were looking for basic information and advice. These people were not or had not yet been involved in a patient’s outpatient treatment.
Epilepsy care is going to be facilitated with teleneurology. It is thought that the era of telemedicine itself dates back to a 1905 ECG transmission via a telephone. Since then, teleconferencing EEG information and interpreting results has proven feasible. With video links and Internet connections, this information can be delivered and accessed faster for the benefit of the patient. Nurse-led clinics can take care of these patients all while having a neurologist review EEG results using remote methods.
Epileptic patients often have difficulty travelling, so this is a much-needed tool for them. Nursing clinics would be able to offer medication advice for them using teleconferencing tools with neurologists. Patients can return home following a local teleconference and take advantage of information gleaned during the teleconference about managing seizures.
Stroke management is another area of neurology that can benefit with teleneurology. The term telestroke was devise in 1999 to note the use of telemedicine for the purpose of managing strokes. This was also prompted by the urgency with which thrombolytic treatments must be done. At the time, real-time video links were the chosen medium but a web-based link system is expected to be developed soon. The National Institutes of Health Stroke Scale can be reliably used in video links according to recent studies. Telephoned cognitive tests are used most often to diagnose post-stroke dementia.
Telestroke is routine in some locations for thrombolysis and overall stroke management. It is best used in underserved or rural areas. In fact, developments in telestroke have been so advanced that telestroke programmes have been recommended. These are predicated on existing evidence for a high quality of care.
Teleneurology is a major part of today’s neurologicial practices. Both patients and clinicians are benefiting from the speed, convenience and ease of this technology. It is now an integral part of modern diagnoses, treatments and follow-up care. Like any medical intervention, it has both benefits and risks. Any proposed applications such as medical online searches, must be developed with a large degree of quality control and accuracy. Clinicians must also be aware of the benefits and risks associated with patient initiated teleneurological care.