1. General Teleneurology
A solution for limited neurology access in SC
Sujai ‘Ron’ Nath, MD
October 15, 2015

2. Disclosures
None

3. Objectives Review the types of care provided by a general neurologist
Review the current status and needs of neurology care in SC
Discuss the how general teleneurology is a solution to provide expert neurological care

4. Overview Background Current status The Need Challenges Solutions
Future

5. Background:Teleneurology
Neurology care through remote means (real-time or delayed)
Inpatient – Neurohospitalist care
Outpatient – clinic only
Neurodiagnostics
Intraoperative Monitoring (IOM)

6. Background: Inpatient
Neurohospitalist care: Neurology in the hospital setting (incl ER)
Provided by board-certified neurologists, fellowship trained
Same premise as “Hospitalists” in the field of general internal medicine

7. Background: Outpatient
Traditional office based practice with scheduled visits
Chronic disorders
Often subspecialty clinics
MS, dementia, headache, movement disorder, epilepsy

8. Background: Diagnostics
Lumbar punctures
EMG/NCS
Evoked potentials
EEG

9. Background: IOM Remote visual review of signals
Mostly spine cases, some brain
SSEP, TceMEP, EMG, EMG, BAER, VEP, mapping
Interact with technician and surgeon

10. Background: Disorders
Inpatient and Outpatient settings
Determined by severity and acuity – dementia vs. delirium
CNS: stroke, MS, tumor, seizure, coma, headaches
PNS: GBS, MG, myositis, radiculopathy

11. Current Status: Overall
~70 hospitals in SC serving a populace of 4.8 million
Ranges: 25 beds to 800 beds with a total of 12,300 beds
Neurological disease burden affects 15% of the population (800,000 people in SC)
25 beds (Allendale and Williamsburg) 800 beds (Greenville)

12. Status: Inpatient
Estimated 500k overall admits per year (about 1300/d)
At least 20% involve a significant neurological disorder (260/d)
Almost completely consultative
Number of consults increases based on availability

13. Status: Outpatient
Estimated 1 million neurology-related outpatient visits per year
Estimated 160 neurologists in SC but nearly half in Charleston
Estimated wait is 4-5 weeks
Not clear how many hours per week in clinic

14. Status: Diagnostics&IOM
Hard to gauge numbers in SC since there is no single source
EEG: 250,000 per year
EMG/NCS: 130,000 per year
About 8000 spine cases per year

15. Need: Inpatient
Typical load is about 1 neurology patient per beds (5%)
A single full-time neurohospitalist needs a census of about 15-20
This does not include ED consults or phone consults
So a hospital needs beds to support one full-time neurohosp

16. Need: Outpatient
Nationally there is 1 neurologist for every 19,000 people
In SC there is 1 neurologist for every 30,000 people
Goal is 1 for every 18,000
SC is short 100 neurologist!

17. Need: Diagnostics&IOM
At least 20% increase across the board in testing but they cant get access
Nearly all 8000 spine cases should be monitored but no access to IOM trained neuro

18. Challenges: the shortfall
Increasing neurological disease burden as population ages
Less students choosing neurology
Significant reduction in hours and insurance-based access
Uneven distribution

19. Ideal Solutions More neurologists overall Better distribution
Better hours
Better access

20. Real Solution: Teleneuro
Allows neurologist to stay in desirable geographic locations
Allows smaller hospitals and communities access
Allows larger hospitals to fill-in gaps of coverage

21. MUSC Teleneurology Complements and builds on success in telestroke
2 full-time neurohospitalists covering 5 hospitals
Provide daily scheduled consults and urgent consults

22. Goals
Expand services and inpatient coverage to all hospitals that need it in SC
Begin to provide outpatient, IOM and diagnostic neurology service

23. Future Teleneurology will become part of residency training
Additional competition from non-profits such as Cleveland Clinic and for-profit companies such as Specialists on Call

24. References
Neurological Disorders: Public Health Challenges (ISBN )
An analysis of avoidable admissions to a neurology service (Rev Neurol 2006 Dec)
Supply and demand analysis of the current and future US neurology workforce (Neurology 2013 Jul)
How can teleneurology improve patient care (Nature Clin Prac Neuro (2006:vol 2, no.7)
Teleneurology applications: Report of the telemedicine workgroup of the AAN (Neurol 2013 Feb)
Advantages and limitations of teleneurology (JAMA Neurol 2015 Mar)