Ten years ago when we made our first forays into teleneurology, our efforts were met with doubt and suspicion. Some of our neurologist colleagues saw teleneurohealth as a corporate conspiracy to replace them. Others doubted that a “doc in a box” could provide compassionate, high-quality care.
Fast forward to today, and it’s rare to find a hospital — from a comprehensive stroke center to the smallest rural hospital — that doesn’t use some form of teleneurology. In fact, it’s probably fair to say that you can’t have an effective neurology program today without it. While this was true before the coronavirus pandemic, our national emergency has exponentially accelerated the demand for virtual care solutions.
Force Multiplying Neurologists Through Virtual Care
Over the past decade, it’s become clear that the relatively small number of practicing neurologists can’t meet the needs of a rapidly aging population by using traditional in-person care models. Instead, we must innovate solutions that allow individual neurologists to care for more patients across a wider geographic area.
This is especially true when it comes to treating acute stroke. Medicine has advanced to the point where timely administration of thrombolytic therapies can save many patients from a lifetime of disability. Because these drugs must be administered within a narrow window (under 30 minutes is currently the gold standard), there is zero time for an on-call neurologist — who is likely not a stroke specialist — to drive to the hospital and perform a workup.
Telestroke programs will continue to serve as the most cost-effective and high-quality way to bridge this gap. In particular, this model ensures that subspecialists who treat high volumes of stroke cases each week are the ones delivering care – even in remote locations. The next generation of telestroke care will likely integrate artificial intelligence (AI) to support neurologists’ diagnostic decisions, leading to faster, more targeted treatments. This technology may act as an additional force multiplier, allowing a single stroke neurologist to manage more patients.
Research suggests that continuous EEG (cEEG) monitoring of patients in neurocritical care units lowers mortality by up to 20%. Specifically, cEEG can help to detect and differentiate seizure activity, allowing for early and effective intervention. CEEG can also improve outcomes for NICU patients who experienced hypoxia during birth, hospitalized epilepsy patients, and any patient with altered mental status.
Despite its benefits, cEEG remains underutilized, in large part because there aren't enough clinical neurophysiologists to manage this vital service. The pandemic has only deepened the shortage. Fortunately, cEEG technology has advanced to a degree that lends itself to remote monitoring. This allows off-site neurologists to direct the care of multiple patients from almost anywhere.
Mobile Stroke Units
COVID-19 has caused significant upheaval in the care continuum. Ten weeks into the pandemic, stroke-related ED visits had declined by 20%. Patients who did visit were often outside the treatment window for thrombolytic therapy and at-risk for poor outcomes. Some had been experiencing serious stroke symptoms (like weakness) on one side for days. Also, the demographic of stroke patients has shifted younger due to complications resulting from COVID-19. Reports from New York City hospitals demonstrate that the mean age for stroke patients testing positive for COVID-19 is 59 years, compared to 74 years for patients testing negative for the coronavirus.
While ED visits have slowly rebounded, this experience revealed a weakness in our existing system. When we expect patients to travel to the ED for care, we increase their risk for delays and resulting complications. The pandemic has highlighted a bigger underlying issue and may give us the push we need to shift to a new paradigm: delivering acute care where and when patients need it.
In the next few years, we expect to see an expansion of telestroke programs that pair neurologists with mobile stroke units — ambulances equipped to perform CT scans and administer thrombolytic therapy in the field. Working together, the neurologist and paramedics can identify patients who would benefit from advanced interventional treatments and transport them to a hospital with these capabilities.
Redefining the Neurology Profession
As we’ve discussed, neurology practice will no doubt evolve in coming years to meet the needs of a rapidly aging population. Future neurologists will likely spend less time on direct patient care and more time consulting and collaborating virtually with front-line care teams. This will allow the relatively small number of neurologists to support the increasing number of highly complex patients.
This virtual care model has proven particularly valuable during the COVID-19 pandemic, where critical care and hospital medicine teams have relied on virtual neurology consults, even within the hospital. The required use of personal protective equipment (PPE) and extra precautions when treating patients during the pandemic can result in stroke treatment delays. However, virtual care permits us to rapidly see and diagnose patients without the risk of viral transmission.
We believe this delivery model has advantages, but also risks – especially given the challenges our profession already faces with high rates of burnout. Because neurological conditions are so often disabling and distressing, neurologists have historically formed strong bonds with their patients. The shift to virtual care may feel distancing and impersonal, compounding compassion fatigue.
As we redefine neurology practices to best serve our communities, it’s vital that neurologists lead the change and create a sustainable practice model. This new vision will help relieve the administrative burden on neurologists and create an opportunity to improve work-life balance. Instead of local physicians always on-call or scrambling to cover vacations with colleagues from nearby counties, we’ll be able to create true teams that support every patient and every clinician.
Vituity's Vision of Innovation
This is the reality in our own organization today. When we founded the neurology practice at Vituity in 2017, we had a vision to build a national practice that made it possible for all communities to access state-of-the-art neurology care. Only three years in, we’ve built a community and a new practice model that truly advances the standard of care.
A standout example is our teleneurohospitalist program — the first of its kind — in which neurologists round virtually with onsite advanced providers. Our training and education programs also focus on the leadership and business skills neurologists will need to redesign care, including the nation’s first administrative fellowship in neurology. Several of our neurologists are also working with tech companies to develop cutting-edge care solutions, including implementing remote cEEG at hospitals across the country.
At a time of uncertainty and disruption, Vituity neurologists have a voice in their practice from day one. As shared owners, they are members of a supportive community that looks out for its own. At Vituity, there’s no need to wait to see what the future holds. With the support of physician leadership and a robust practice management infrastructure, neurologists will actively shape their practice — not to mention the future of healthcare.
“As we redefine neurology practices to best serve our communities, it’s vital that neurologists lead the change and create a sustainable practice model.”
Yafa Minazad, DO
Transforming Neurology Solutions
The deep disruption caused by the pandemic represents an opportunity for neurologists to lead the transformation of care delivery. Physicians know best the challenges their patients face and how to address them. Hospitals, health systems, and physician groups that engage neurologists in the evolution will be ready to meet the growing demands for neurology care.
Join the team that’s transforming healthcare. Explore our Neurology job openings.