Teleneurology service provided via tablet technology: 3-year outcomes and physician satisfaction

Kelly Harper; Megan McLeod; Summer K Brown; Georgia Wilson; Maxim Turchan; Emily M Gittings; Derek Riebau; Mark Baker; Eli Zimmerman; David Charles

doi:10.22605/RRH4743

Project Report

Teleneurology service provided via tablet technology: 3-year outcomes and physician satisfaction

AUTHORS

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Kelly Harper¹ BPS, Program Manager

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Megan McLeod² BBA, Medical Student

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Summer K Brown³ BA, Masters student

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Georgia Wilson⁴ BA, Clinical Research Coordinator I *

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Maxim Turchan⁵ BA, Health and Policy Services Analyist II

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Emily M Gittings⁶ Student

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Derek Riebau⁷ MD, Assistant Professor

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Mark Baker⁸ MD, Assistant Professor

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Eli Zimmerman⁹ MD, Assistant Professor

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David Charles¹⁰ MD, Professor and Vice-Chair of Neurology, Medical Director Vanderbilt TeleHealth

AFFILIATIONS

^{1, 5, 7, 8, 9, 10} Vanderbilt University Medical Center, Nashville, Tennessee, USA

² University of Mississippi, Oxford, Mississippi, USA

³ Vanderbilt University, Nashville, Tennessee, USA

⁴ Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

⁶ McGill University, Montreal, Canada

ACCEPTED: 20 November 2018

Now published, see the full article

Early Abstract:

Purpose: To demonstrate that teleneurology consultations conducted via tablet technology are an efficient and cost-effective means of managing acute neurologic emergencies at community-based hospitals and that utilizing such technology yields high community physician satisfaction.

Methods: During a 39-month period, Vanderbilt University Medical Center (VUMC) provided teleneurology services to ten community-based hospitals that lacked adequate neurology coverage. Hospitalists at one community-based hospital were not comfortable treating any patient with a neurologic symptom, resulting in 100% of those patients being transferred. This facility now retains more than 60% of neurology patients. For under $1200, these hospitals were able to meet the only capital expenditure required to launch this service: the purchase of handheld tablet computers. Real-time teleneurology consultations were conducted via tablet using two-way video conferencing, radiologic image sharing, and medical record documentation. Community physicians were regularly surveyed to assess satisfaction.

Results: From February 2014 to May 2017, 3,626 teleneurology consultations were conducted. Community physicians, in partnership with neurologists, successfully managed 87% of patients at the community-based hospital. Only 13% of patients required transfer to another facility for a higher level of care. The most common diagnoses included stroke (34%), seizure (11%), and headache/migraine (6%). The average time for the neurologist to answer a request for consultation page and connect with the community physician was 10.6 minutes. Ninety-one percent of community physicians were satisfied or somewhat satisfied with the overall service.

Conclusions: In the assessment of neurology patients, tablets are a more cost-effective alternative to traditional telehealth technologies. The devices promote efficiency in consultations through ease of use and low transfer rates, and survey results indicate community physician satisfaction.