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Neurology: The Next Frontier in Telehealth?

August 28, 2014
by Gabriel Perna
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Miles E. Drake, M.D., professor emeritus of psychology and neurology at the Ohio State University, has a long history with telehealth.

When the neurological doctor was at Duke University Medical Center, he had experience with the telephonic transmitting brain wave recordings.  Drake also participated in neurological consultations through telehealth with state prisoners in Ohio. Lastly, he was involved with the telehealth through continuing medical education programs at the Ohio Medical Education Network.

These experiences had heightened his interest in telehealth. He recently wrote a comprehensive paper on the subject and has often explored potential areas it could impact medicine. Healthcare Informatics Senior Editor Gabriel Perna recently had a discussion with Drake about how telehealth could be applied in the field of neurology. Below are excerpts from that interview.

Miles E. Drake, M.D.
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What are the overall opportunities you see within telehealth?

I think it’s an interesting and promising area of medicine. Most things about medical practice tend to get more expensive and more complicated as we develop new technologies and train new people to do them. With video and computer-assisted exchange of information, this technology is getting cheaper and easier to use. There is not much in the American health system that is getting cheaper and simpler to use than it used to be.

It is a very promising area for medical education and for some areas of consultation. We’ve seen it used already in other areas of the country, particularly in the western states where there is several hundred miles between the [patient and provider]. I think there are limitations to telehealth. It would be very hard to feel’s someone’s liver, palpate lymph nodes, or to do examinations used in gynecology at a distance. It need not be used for those purposes. It is promising way of expanding certain kinds of healthcare services, when distance and population are an issue.

Your paper included several clinical applications for telehealth, but what about specifically within neurology?

Neurology may not be as ideal as some areas. For example, the data suggests that psychiatry and mental health may actually be more effective and more efficient. Both of those are promising areas because much of the diagnostic process centers upon on what the patient says, how they are describing their symptoms. There are few objective that assist diagnoses. Most can be made by listening to the patient, hearing descriptions of patient’s behavior and watching how the patient conducts himself and speaks. These are obviously things that can be done by video.  

Neurology is not as ideal [as psychiatry] because there are some things like muscle tone, the extent to which a limb resists being moved. You have to feel the arm and the leg to interpret. But much of the diagnosis involves watching how the patient walks, how they move, observing the kind of tremor or involuntarily movements the patient has. You can easily do that on video. So conditions like multiple sclerosis and Parkinson’s disease may lend themselves to that. In some neurological areas, such as headaches and most kinds of pain as well as epilepsy, the patient is usually normal and unremarkable in appearance at the time they are evaluated. Since ancient time, the evaluation has consisted most of patient’s description of what the symptoms have been at other times. There is no reason that couldn’t be done by some telephonic/computerized/video means.

Are there any other barriers/opportunities you can think of for teleneurology?

I think those have been the chief ones. The elicitation over a distance of the kind of symptoms, you’d talk with a patient face to face. This is also true in psychiatry and psychology, areas in which patient interview is important. The telephonic or digital transmission of imaging studies have also shown to be effective. Those imaging studies can easily be transformed into digital signals and transmitted over long distances. There are digital imaging communication (DICOM) standards that make it possible to transmit images from the hospital where they’re acquired to the center where they are interpreted. It would allow, for example, an MRI to be done at a local hospital and interpreted by a tertiary specialist at a center far away. That’s another neurological area where telehealth may prove to be helpful.

How do you see telehealth evolving?

It will allow medical specialist consultation, neurological and otherwise, to be done where there isn’t always a specialist and where there is only occasionally a patient that needs those services. We may be able to get by with fewer specialists and still not have a deleterious effect on patient care. Likewise, we may be able to give the patient in the small, rural community the same kind of study and interpretation as he would get at a major teaching hospital some distance away. This is another area which improvement of care and savings of cost has been reported. Patient transportation from the rural hospital to the medical center may be avoided and people not make as many visits to specialists if some of this can be done by telephone or by computed means.