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Among the more hotly contested sessions at the American Academy of Neurology’s 2021 Virtual Annual Meeting, was a debate at the Controversies in Neurology Plenary Session on Wednesday, April 21, 2021 about whether teleneurology could ultimately replace in person visits. The debaters included Tamika Burrus, MD, a vascular neurologist with SOC Telemed, Inc. arguing “yes,” versus Amy Guzik, MD, Associate Professor of Neurology and Director of the Comprehensive Stroke Center at Wake Forest Baptist Health, arguing “no.” Contributing to the importance this question, of course, has been the widespread adoption and implementation of teleneurology across all aspects of neurological care during the course of the COVID-19 pandemic this past year. 

During her time, Dr. Burrus touted data from the Department Veterans Affairs (VA) Healthcare System, suggesting that the majority of patients care more about access than human interaction, and cited a number of studies of teleneurology for various disease-based populations showing generally wide acceptance and satisfaction among neurology patients. She also argued that “the Internet should be a public utility” and highlighted initiatives from the FCC to incentivize virtual connected care for patients in their homes and mobile locations and expand rural broadband for telehealth services. 

Alternatively, Dr. Guzik, who acknowledged her role as Director of the Wake Forest Telestroke Network, revealed gaps in our telehealth systems of care that limit the feasibility, accessibility, and sustainability of teleneurology today. In particular, she argued that our current neurology clinical workflows and ambulatory infrastructure are not adapted to seamless telehealth delivery for all patients, and that reimbursement models expanded during the pandemic would need to be continued and expanded to support the broad practice of teleneurology going forward. Dr. Guzik also referenced previously published data regarding the rapid implementation of outpatient teleneurology during the pandemic that elicited concerning disparities in age, sex, race/ethnicity, and socioeconomic factors leading to lower adoption of video visits in ostensibly higher-risk patient populations (Strowd Neurology Clinical Practice 2020). From the clinician perspective, she shared data that most neurologists feel comfortable with telemedicine for return or follow-up visits, but only about half feel it is appropriate for initial visits or new symptoms where the hands-on neurological exam holds greater import. 

Dr. Burrus rebutted that new legislation in the wake of the pandemic will enhance teleneurology delivery and help eliminate these noted disparities, including bipartisan support for the Telehealth Modernization Act that seeks to eliminate geographic originating restrictions and establish the patient’s home as an eligible distant site. While the future of new policies and legislation supporting sustainable telehealth hangs in the balance, Dr. Guzik returned that the answer to the question of whether teleneurology can fully replace in-person visits is “not right now.” She further proffered that the more pertinent question may not be whether teleneurology can replace in person visits, but whether it should at any point in the future. In her own words, “telemedicine is just one tool in our doctor’s bag and that the optimal balance going forwardx is going to be a combination of in person and telehealth visits, including audio only.”

“For sustainable telemedicine post pandemic,” she summarized, “we must advocate for the support to move technology forward and reach all patients where they are.” 

Andrew M. Southerland, MD, MSC, FAHA is the Associate Professor of Neurology and Public Health Sciences at the University of Virginia.

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