PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of neurologyNeurologyAmerican Academy of Neurology
 
Neurology. 2013 February 12; 80(7): 670–676.
PMCID: PMC3590056

Teleneurology applications

Report of the Telemedicine Work Group of the American Academy of Neurology
Lawrence R. Wechsler, MD, FAAN,*

Scientific Advisory Boards:

  1. Lundbeck/DSMB/2008-present, Neurointerventions/ SAB/ 2008-present, Silk Road Medical/ SAB/ 2012

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. UPMC Telemedicine network provides telestroke services to hospitals in Pennsylvania and Maryland.

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. 5R01NS046309 [PI] 2008-2010, U01NS062851 [PI] 2009-2010, 2R01NS039325 [PI] 2009-2010, U01NS051483 [Site PI] 2007-2010, U01NS40406 [Site PI] 2006-2010, 5R01NS038384 [Site PI] 2004-2011, 1U10NS077272-01 [Co-PI] 2011-2012

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. Neurointerventions

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. Neurointerventions 2009-present, Silk Road Medical 2012

Legal Proceedings:

  1. NONE
Jack W. Tsao, MD, DPhil, FAAN,*

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. Continuum, Traumatic Brain Injury issue, Guest Editor, 2010

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. United States Army Telemedicine & Advanced Technology Research Center, Development of a Military Teleneurology System, Principal Investigator, 09/30/06-9/30/11

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. Illumina, 2010-12; Biogen, 2010-12

Legal Proceedings:

  1. NONE
Steven R. Levine, MD,

Scientific Advisory Boards:

  1. (1) Independent Medical/Safety Monitor for NINDS-funded IMS 3, FAST MAG, INSTINCT, and CLEAR-ER, (2) Adjudication committee for NINDS-funded WARCEF

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. (1) Genentech-sponsored investigator meeting - travel expenses reimbursement in 2010, 2011

Editorial Boards:

  1. (1) MEDLINK, Associate Editor, 1996-present, (2) National Stroke Association, scientific content advisor, 2010, 2011

Patents:

  1. NONE

Publishing Royalties:

  1. (1) Book: Transient Ischemic Attacks, Blackwell Futura, 2004

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. (1) Genentech-sponsored investigator meeting - consultant, 2010, (2) Genentech study on cost-effectiveness of primary stroke centers, 2011 - consultant within a study group

Speakers' Bureaus:

  1. (1)Medical Education Speakers Network, lecturer, 2008-2012, (2)NCME, lecturer, 2008-2011

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. (1)NIH-NHLBI 1R01 HL096944, principal investigator, 2009-2013, (2) NIH-NINDS 1UO1 NS044364, Independent safety monitor, 2003 - 2012, (3) NIH-NINDS 1 U10 NS077378,PI, 2011 - 2017, (4) NIH-NINDS 1 U10 NS080377, PI, 2012 - 2017, (5) NIH-NINDS 1 R25 NS079211, MPI, 2012- 2017, (6) The Patient-Centered Outcomes Research Institute (PCORI) 1IP2PI000781, scientific PI, 2012-2014, (7) NIH-NIA 1 R01 AG040039, Co-I, 2011-2016, (8) NIH-NINDS 2 P50 NS044283, safety monitor, 2008-2013, (9) NIH-NINDS 2 U01 NS052220, independent medical monitor, 2005-2013

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Rebecca J. Swain-Eng, MS,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. Employee of the American Academy of Neurology

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Robert J. Adams, MS, MD,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. Travel expenses are paid when I give a lecture for Genentech

Editorial Boards:

  1. NONE

Patents:

  1. REACHCall inc telemedicine system

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. Genentech speaker Bureaau 2011-2012

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. Genentech

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. Subcontract from Georgia State UNiversity regarding telemedicine adoption, the sponsor was Genentech

Research Support, Government Entities:

  1. Funding from NHLBI for Sickle Cell Research, Funding from the Department of Defense for stroke prevention work in South Carolina

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. I hold IP rights for telemedicine technology and receive royalites of less than $ 1500 per year for the last two years.

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. yes I own stock in REACH Health, inc a telemedicine platform provider

Legal Proceedings:

  1. NONE
Bart M. Demaerschalk, MD, MSc, FRCP(C),

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. (1) Stroke, editorial board since 2006, (2) Hospital Practice, editorial board since 2009, (3) The Neurologist, section editor, 2007, (4) Journal of Stroke and Cerebrovascular Diseases, editorial board since 2009.

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. (1)Genentech, (2)National Stroke Association

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. (1) AGA, RESPECT trial site PI, 2009, (2) Vernalis, VASTT trial site PI, 2008, (3)NBT, ASP trial site PI, 2008, (4) MITSUBISHI, trial site PI, 2009, (5-6) Abbott, CHOICE and ACT I, co-investigator, 2009, (7) Penumbra, PICS, co-investigator, (8) Vernalis, DSMB member for IN-STEP, 2009, (9) Axio, event adjudicator, 2009, (10) Neuralieve, medical monitor,(11) Genentech and National Stroke Association, Advancing Telestroke Care, Steering Committee Member

Research Support, Government Entities:

  1. (1) ADHS, STRokE DOC AZ TIME, PI, 2009, (2) ADHS, STARR PI, 2009, (3) NINDS, IMS III, site PI, 2009 (4) NINDS, SAMMPRIS, site PI, 2009, NINDS, (5) SPS3, site PI, 2009, (6) NINDS, CREST, site PI, 2008, (7) NINDS, ALIAS II, co-investigator, 2009, (8) POINT, co-investigator, 2011, (9) MR RESCUE, co-investigator, 2010

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
David C. Hess, MD,

Scientific Advisory Boards:

  1. 1.) Pfizer-DSMB,.2.) Advisory Board-Sanofi,.3.) Advisory Board-Lundbeck,.4.) NIH-NINDS DSMB,.5.) STAIR (Stroke Academic Industry Roundtable),.6.) Translational Sciences, Inc

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. Memorial Hospital, Gulport, Mississippi,.Georgia Health Sciences CME Program

Editorial Boards:

  1. Editorial board Stroke,.Editorial Board-Cell Transplantation,.Editorial Board-Experimental and Translational Stroke

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. Mesoblast, Inc,.Translational Sciences, Inc

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. Our department of Neurology receives compensation for,.providing telestroke coverage to a number of Georgia hospitals

Research Support, Commercial Entities:

  1. 1.) Athersys, Inc-research contract of stem cells in stroke,.2.) Lundbeck, Inc

Research Support, Government Entities:

  1. 1.) NINDS/NIH RO1 . Early phase trial of minocycline in acute stroke

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. Board of Directors of Health, Inc. I have travel expenses.compensated but no salary and no stock options for this duty.

License Fee Payments, Technology or Inventions:

  1. Licensing revenue from REACH Health, Inc a telestroke,.company for development of web-based telestroke system

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. Founder's equity in REACH Health Inc, a telestroke company. I am one of 9 co-founders

Legal Proceedings:

  1. Legal consulting on three cases in past 2 years for total sum of about 8000.00
Elena Moro, MD, PhD,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. Medtronic, speaker honoraria

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. Medtronic Canada, educational consultant

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. St. Jude

Research Support, Government Entities:

  1. CIHR-AF-BMBF grant, Co-PI, 2 years

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. 1) Sickkids Foundation (and IHDCYH), Co-PI, 2 years,.2) CurePSP, PI, 2 years

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Lee H. Schwamm, MD,

Scientific Advisory Boards:

  1. Serve on the scientific advisory boards for (1) CoAxia; (2) Lundbeck DIAS 4 steering committee; (3) LifeImage (4) Medtronic

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. Neurocritical Care, Editorial board (2007-),.Stroke, editorial Board (2010-),.Frontiers in TeleNeurology, Editorial board (2010-)

Patents:

  1. (1) Schwamm LH, Sorensen AG, inventors; The General Hospital Corporation assignee. Imaging system for obtaining quantitative perfusion indices. US Patent 6,542,769. 2003 Apr 1.

Publishing Royalties:

  1. (1) Acute Ischemic Stroke: Imaging and Intervention, 2nd Edition. Heidelberg, Germany: Springer-Verlag GmbH; 2011

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. see advisory boards, (1) Consultant to Mass Dept of Public Health on stroke systems of care, (2) RTI Health

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. Site-PI for DIAS-4, Lundbeck

Research Support, Government Entities:

  1. NIH/NINDS, co-investigator,P50 NS051343-01 NIH/NINDS, site PI, U01 NS052220 IMS-3, HRSA, PI, HHSH 250200927063P (2009-2010)

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. (1) LifeImage, 2011,2012

Legal Proceedings:

  1. (1) CRICO and Risk Management Foundation; provide expert pre-trial review of cases involving stroke or traumatic brain injury (2010-)
Steve Steffensen, MD,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Barney J. Stern, MD, FAAN,

Scientific Advisory Boards:

  1. I have served on a NIH DSMB.

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. I have received honoraria for speaking at non-profit entities.

Editorial Boards:

  1. I have received compensation as Editor of The Neurologist over the past 19 years.

Patents:

  1. NONE

Publishing Royalties:

  1. I have received royalties for contributing to publications in UpToDate and Medlink.

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. My academic medical center is developing a tele-stroke program in which I will participate. During the course of developing this manuscript, I did not participate in tele-stroke services.

Research Support, Commercial Entities:

  1. I received payment for per patient enrollment in a stroke study sponsored by Remedy Pharmaceuticals, Inc.

Research Support, Government Entities:

  1. 2008 - 2012 Medical Safety Monitor. (10%), “Stenting and Aggressive Medical Management for Preventing Stroke in Intracranial Stenosis (SAMMPRIS)” NIH NINDS R01 NS058728-01A1. Marc Chimowitz, MBChB, Principal Investigator. 2007 - 2012, Principal Investigator. “Neurological Emergencies Treatment Trials (NETT) Network Clinical Site Hubs” NIH NINDS 1 U10 NS058932-01. 2008 - present Co-Investigator Albumin in Acute Ischemic Stroke (ALIAS) NIH NINDS: ALIAS is a clinical trial ithin the NETT Network Myron Ginsberg, MD, Principal Investigator, 2009 - present, Co-Investigator Progesterone for Traumatic Brain Injury: Experimental Clinical Treatment (ProTECT) NIH NINDS: ProTECT is a clinical trial with the NETT Network, David Wright, MD, Principal Investigator 2010 - present, Co-Investigator Platelet-Oriented Inhibition in New TIA and minor ischemic stroke (POINT) Trial, a prospective, randomized, double-blind, multicenter clinical trial, NIH NINDS: POINT is a clinical trial with the NETT Network, S. Claiborne Johnston, MD, PhD, Principal Investigator, 2008 - 2011, Co-Investigator Rapid Anticonvulsant Medications Prior to Arrival Trial (RAMPART), NIH NINDS: RAMPART is a clinical trial with the NETT Network, Robert Silbergleit, MD, Principal Investigator, 2008 - 2011, Medical Safety Monitor. Chronic Migraine Treatment Trial (CMTT), NIH NINDS Clinical Research Collaboration 08-CRC-01, David Dodick, MD and Stephen Silberstein, MD, Principal Investigators, 2003 - 2012, Medical Safety Monitor “Secondary Prevention of Small Subcortical Strokes (SPS3)” NIH NINDS 2 U01 NS038529-04A1. Oscar Benavente, MD, Principal Investigator.

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Steven J. Zuckerman, MD, FAAN,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Pratik Bhattacharya, MD, MPH,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. Wayne State University, Assistant Professor- Department of Neurology: Comprehensive Stroke Program. Michigan Stroke Network: Vascular Neurologist.

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. The Wayne State Comprehensive Stroke Program uses Telemedicine to provide acute stroke services to patients in several hospitals across the state of Michigan. About 10% of total effort.

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
Larry E. Davis, MD,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. Royalities for writing Fundamentals of Neurologic Disease by Demos in 2005

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. VA office of Rural Health VA staff funding to explore giving care to remote patients with Parkinson's disease via teleneurology in the VA. One year staff funding.

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. One time consultant to legal firm regarding West Nile encephalitis- 2012
Ilana R. Yurkiewicz, BS,

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
and Aimee L. Alphonso, BS

Scientific Advisory Boards:

  1. NONE

Gifts:

  1. NONE

Funding for Travel or Speaker Honoraria:

  1. NONE

Editorial Boards:

  1. NONE

Patents:

  1. NONE

Publishing Royalties:

  1. NONE

Employment, Commercial Entity:

  1. NONE

Consultancies:

  1. NONE

Speakers' Bureaus:

  1. NONE

Other Activities:

  1. NONE

Clinical Procedures or Imaging Studies:

  1. NONE

Research Support, Commercial Entities:

  1. NONE

Research Support, Government Entities:

  1. NONE

Research Support, Academic Entities:

  1. NONE

Research Support, Foundations and Societies:

  1. NONE

Stock/Stock Options/Board of Directors Compensation:

  1. NONE

License Fee Payments, Technology or Inventions:

  1. NONE

Royalty Payments, Technology or Inventions:

  1. NONE

Stock/Stock Options, Research Sponsor:

  1. NONE

Stock/Stock Options, Medical Equipment & Materials:

  1. NONE

Legal Proceedings:

  1. NONE
For the American Academy of Neurology Telemedicine Work Group

Abstract

Objective:

To review current literature on neurology telemedicine and to discuss its application to patient care, neurology practice, military medicine, and current federal policy.

Methods:

Review of practice models and published literature on primary studies of the efficacy of neurology telemedicine.

Results:

Teleneurology is of greatest benefit to populations with restricted access to general and subspecialty neurologic care in rural areas, those with limited mobility, and those deployed by the military. Through the use of real-time audio-visual interaction, imaging, and store-and-forward systems, a greater proportion of neurologists are able to meet the demand for specialty care in underserved communities, decrease the response time for acute stroke assessment, and expand the collaboration between primary care physicians, neurologists, and other disciplines. The American Stroke Association has developed a defined policy on teleneurology, and the American Academy of Neurology and federal health care policy are beginning to follow suit.

Conclusions:

Teleneurology is an effective tool for the rapid evaluation of patients in remote locations requiring neurologic care. These underserved locations include geographically isolated rural areas as well as urban cores with insufficient available neurology specialists. With this technology, neurologists will be better able to meet the burgeoning demand for access to neurologic care in an era of declining availability. An increase in physician awareness and support at the federal and state level is necessary to facilitate expansion of telemedicine into further areas of neurology.

Telemedicine is a rapidly progressing field that is constantly revising the possibilities for high-quality patient care. Telemedicine includes multiple applications and services including remote videoconferencing (2-way video), e-mail, and other forms of technology. The use of telemedicine is now becoming integrated into the daily life of physicians, hospitals, specialty departments, home health agencies, and patients.1

Telemedicine in acute stroke demonstrates validated uses of telemedicine likely appropriate in other neurologic conditions. The benefits and lessons learned from telemedicine in acute stroke may serve as a model for the continued expansion of telemedicine into other areas of neurology.

TELENEUROLOGY AND THE PATIENT

Neurology telemedicine, also known as “teleneurology,” has been used to improve access to neurologic expertise for patients in locations with a lack of access to specialists or for those patients with neurologic disabilities restricting travel or requiring time-sensitive care. Telemedicine provides services that cannot easily be provided face to face and improves the efficiency or effectiveness of existing services.1 Wherever access to neurologic expertise is limited, either by inadequate numbers of providers or by impaired mobility of patients, exists a potential opportunity for introducing telemedicine to facilitate that access.

While teleneurology is currently most commonly applied in emergency stroke and neurocritical care,2 it also has a role in managing patients with chronic neurologic diseases such as epilepsy,3 Parkinson disease and other movement disorders, new neurologic outpatient referrals or consultations, community rehabilitation programs, neurology e-consults from domestic and global health sources, and e-mail triage of referrals from general practitioners.2 Teleneurology thus is in the unique position to offer specialized care on a scale previously unmatched by conventional care.

For patients with acute or chronic disability due to neurologic diseases that impair mobility, access to neurologic care without extensive travel can be beneficial (table). Telemedicine services can also extend to chronic care facilities such as nursing homes, providing neurologic expertise to patients who otherwise could not be easily transported to a neurology office. Subspecialty neurology care such as movement disorders, epilepsy, or neuromuscular disease may require extended travel for patients in each direction to see an expert, typically located in a major metropolitan area. With telemedicine, an initial evaluation can be accomplished without the need for the patient to leave his or her community. If necessary, the specialist can arrange for patients requiring further study to be evaluated in-person.2 Many patients appreciate the ability to reduce travel times while receiving the same high level of specialty care. In some cases, patients may live so far from major referral centers that an in-person evaluation is not possible. However, remote evaluation by telemedicine will reach patients in any area with appropriate connectivity, typically with a bandwidth on the order of 128 kB/s to 764 kB/s.3

Table
Benefits and barriers to telemedicine implementation

Nearly half of the hospitals in the United States have fewer than 100 beds.4 In most of these hospitals, there is no neurologist on staff readily available. Remote communities are underserviced and have no direct access to a neurologist.5 Ninety percent of rural hospitals surveyed were receptive to involvement in a regional or state teleneurology network of care.6 In many of these rural areas, there is not sufficient workload within a defined geographical area for a neurologic practice to become financially viable. This has led to a “geographical disparity” for neurologic care.7 Time-sensitive neurologic diseases like stroke require rapid assessment by a neurologist or other stroke specialist. While helicopter transfer and telephonic consultations have a role, the majority of stroke specialists and emergency physicians surveyed agreed that telemedicine will reduce geographical differences in stroke management and is superior to telephone consultation.8

Patients can be evaluated and, in many instances, cared for at the rural hospital after a teleneurology consultation. Active teleneurology networks demonstrated an average of 60%–70% patient retention at the local level following telemedicine consultation.9 A hub-and-spoke model has proven to be efficient, safe, and cost-effective. Many rural hospitals face overwhelming financial challenges. However, the cost per neurologic patient to the hospital can be reduced up to 35% using e-mail referrals instead of conventional face-to-face care.10 Both an increase in hospital productivity and patient retention due to telemedicine contribute to the overall cost-effectiveness of teleneurology.11 Keeping appropriately selected patients at the rural facility can further reduce considerably costly transfers and increase safety by limiting the transfers of unstable and critically ill patients. This can contribute to the financial viability of the rural health facility and rural health physicians, thus contributing to the overall cost-effectiveness of any regional teleneurology program.12 Beyond rural health care difficulties, urban hospitals also face major financial challenges and problems with access to rapid neurologic on-site expertise because of traffic patterns in large cities. These problems could be improved with telemedicine by decreasing patient need to travel and by improving outcomes from clinical management.

In 2005, the American Stroke Association proposed a new framework for stroke care delivery modeled after the successful trauma and coronary artery disease systems of care. The goal of this new framework, the Stroke Systems of Care, was to define strategies for implementation of a more coordinated delivery of stroke care across the continuum of services from prevention through rehabilitation.13 This model recommends implementation of telemedicine as one strategy to increase access to acute stroke care in neurologically underserved areas, which include both geographically remote sites and urban areas with limited availability of neurologists with sufficient experience with acute stroke to provide expert care on an emergent basis. The term telestroke was first introduced in 1999 in a concept paper that recommended the use of high bandwidth, dedicated interactive videoconferencing and remote image review to provide the necessary acute stroke expertise lacking in most hospitals across the United States.14 Since then, there have been extensive scientific validation studies of the component steps critical to successful telestroke evaluation, demonstrating the following:

  1. The NIH Stroke Scale via telestroke is reliably performed by both physicians and nonphysicians compared to the traditional bedside evaluation in acute and subacute settings.15
  2. Neurologists can reliably interpret unenhanced brain CT images for the purpose of confirming the diagnosis of acute ischemic stroke and establishing eligibility for IV tissue plasminogen activator (tPA).16
  3. IV tPA can be administered safely through telemedicine and with outcomes comparable to those observed in patients being treated at tertiary care facilities.16
  4. Audio-video telemedicine evaluation of an acute stroke patient leads to better decision-making and safety than telephone-only consultations.5
  5. Telestroke networks have proven cost-effective.17

Opportunities exist for teleneurology beyond acute ischemic stroke. Already there has been demonstration of benefits of telestroke support for the inpatient phase of stroke care beyond just tPA evaluation and administration. Small pilot studies suggest benefits in rehabilitation telemedicine, “telerehabilitation,” and prehospital care.18 Telerehabilitation has the potential to enable successful postacute care for disabled patients in the home so that these patients with limited mobility do not have to travel and clinicians can improve function and prevent complications in a cost-effective manner.19 Telemedicine for neurologic critically ill patients as well as routine hospital consultations are feasible utilizing this technology.20 Telemedicine can also improve screening, consenting, randomizing, treating, and following subjects' enrollment in acute stroke clinical trials. Identification of appropriate patients is enhanced and examinations can be documented by study investigators allowing entry of patients who otherwise might be excluded.21 Thus telemedicine has the potential to improve the recent trends in poor patient enrollment in the United States.

Movement disorders evaluation benefits from remote assessment, as studies have shown that telemedicine is useful for the evaluation and management of Parkinson disease, a disease where patient travel may be especially challenging and costly.22 Telemedicine is already being employed in the following disciplines of neurology and allied specialties: dementia,23 neuro-oncology,24 adult and pediatric neurology, neurocritical care,25 migraine,26 multiple sclerosis,27 epilepsy,3 neurosurgery,28 neuropathology,29 and psychiatry.30 Interpretation of epilepsy monitoring, EEG tracings, and intraoperative monitoring (IOM) are routinely done from distant sites. With the emerging testing of teleradiology imaging (including head CT and CT angiography) being transmitted to handheld devices (e.g., smartphones and tablets), an improvement in rapid access to patient imaging outside the hospital and home will be possible.

Telemedicine can greatly increase the ability of local hospitals or clinics to provide general neurologic consultation services, sleep studies, and EEGs in the absence of an on-site neurologist. In the intensive care unit setting, the use of robotic telemedicine has been shown to significantly reduce response times to cerebral ischemia and elevated intracranial pressure. This translates to significantly reduced lengths of stay and improved cost of care,20 particularly for patients with a greater severity of illness.31

Furthermore, the increasing use of deep brain stimulation (DBS) and IOM via telemedicine is currently used for patients with essential tremor,32 Parkinson disease,22 and primary dystonia,33 and is under investigation for epilepsy, obsessive-compulsive disorder, Alzheimer disease, depression, and other movement disorders.34 The management of patients post-DBS requires assistance from highly specialized teams that may not be immediately available when there is a problem with the DBS system itself. Telemedicine can provide an effective tool to deal with concerns related to the technology involved in managing patients.

BARRIERS TO TELENEUROLOGY IMPLEMENTATION

One drawback of telemedicine is the potential to disrupt the traditional doctor–patient relationship and the resulting reluctance to implement the technology in routine practice. The treatment of illness has long been viewed as a holistic process, with human contact, personal interaction, and direct communication valued as critical components of effective and compassionate care. The fear that telemedicine may alter the doctor–patient relationship necessitates ongoing evaluation and new approaches to optimize the telemedicine interaction.

Despite teleneurology providing neurologic expertise to areas with limited or no neurology coverage, many sites will likely prefer in-person neurology service when available. Comparisons of the neurologic examination performed by teleneurology with in-person examination are limited and show variable correlations depending upon the element of the examination.35 Further study of the application of teleneurology to stroke and other common and uncommon neurologic conditions is warranted. Process measures, reliability of consultation, and outcomes should be monitored to define the limits of telemedicine in this setting. Many small hospitals without neurology coverage are already using teleneurology to provide emergency or ongoing care. The benefits of providing this service to patients in remote areas must be validated through appropriate reports and studies.

For health care providers not specially trained in neurology, performing a complete neurologic examination, particularly the funduscopic examination (as technology matures, a portable retinal camera could be used to accomplish this) and evaluation of muscle tone, strength, sensation, and reflexes, is difficult to achieve. To overcome this barrier, the clinical provider should be present during the televideo examination and should conduct the neurologic examination in front of the camera. Alternatively, a nurse practitioner, physician assistant, registered nurse, or technician who has been trained in the neurologic examination (i.e., a “telepresenter”) could conduct the neurologic examination under the videoconference supervision of a remotely located neurologist.

TELEMEDICINE AND THE PRACTICE OF NEUROLOGY

The use of telemedicine encourages development of networks of providers willing to increase access to neurologic care in underserved rural areas. Telemedicine is a means to triage or pre-evaluate prospective patients to increase practice outreach and efficiency. Evaluation of patients using telemedicine can result in the decision not to see particular patients or to redirect them in the medical care system before an unnecessary clinic visit or hospitalization has been incurred, resulting in cost reduction.

The use of video links for epileptic patients in rural communities is one example of the potential of telemedicine in streamlining health services, with the approach shown to reduce travel time for both doctor and patient with no accompanying changes in quality of care.36

With the growth of retail medicine, delivery of neurology services to urgent care centers or employer health clinics may be facilitated by telemedicine. Primary care offices could utilize telemedicine to obtain rapid neurologic opinions when travel is difficult or the need for an appointment with a neurologist is unclear. These telemedicine applications offer the neurologist additional practice opportunities with a minimal time investment in addition to cost savings in unnecessary referrals or testing.

The education and supervision of residential fellows can be enhanced with telemedicine. For example, an attending physician's direct participation via telemedicine in the evaluation of a patient in the emergency department can improve the efficiency and timeliness of patient care. Furthermore, the capability to archive telemedicine sessions provides a library of simulation scenarios that can be reviewed in an educational setting to evaluate real-world patient encounters. Telemedicine applications can address several core competencies such as patient care, communication, professionalism, and systems-based practice.

Telemedicine networks also provide a unique opportunity for interaction between highly trained and experienced specialist neurologists at medical centers and local neurologists, and between emergency medicine, urgent care, primary care, and non-neurology specialists for educational and mentoring activities. Alliances between smaller hospitals and tertiary care centers (a hub-and-spoke system) for the provision of telemedicine services can easily be expanded to include educational activities. These interactions may include traditional education delivery as well as remote supervision of patient care, performance of procedures, or assessment of competencies along with quality control and performance improvement.

Furthermore, telemedicine facilitates clinical research by providing an infrastructure to recruit patients into clinical trials.21 Information about a clinical study can be conveyed to the patient or surrogate and the consent process initiated. Telemedicine could be used to screen, consent via e-signature, randomize, treat by telepharmacy connections, and even follow up subjects who may remain remotely located in collaborating spoke hospitals. This approach can help recruit additional patients into acute stroke treatment and other clinical trials.

DEPARTMENTS OF VETERANS AFFAIRS AND DEFENSE TELENEUROLOGY

Using teleneurology to provide high-quality neurologic care to veterans and to improve the efficiency of the limited number of neurologists in the Veterans Affairs (VA) system is under development.37

The VA initiative differs from many videoconferencing health systems being developed for the private sector in that the VA will deliver direct patient care as well as neurologic consultations and education. In the remote epilepsy care model, veterans will only have to travel to their local community-based outpatient clinics where they will be connected by a sophisticated video conferencing system to an epileptologist. Follow-up management of the patient's epilepsy and anticonvulsants will be accomplished with the opportunity of the patient, caregiver, and primary care provider to interact in real time. Pilot plans are under way to expand this remote care system to include chronic care in patients with Parkinson disease, post-stroke, traumatic brain injury, spinal cord injury, and dementia.

The shortage of active duty neurologists leads to reliance upon neurologists in the local community to care for military service members, dependents, and retirees. For medical personnel operating in remote environments, neurology support via telemedicine consultation is critical. The US military currently relies heavily upon store-and-forward asynchronous telemedicine consultation for neurologic disorders in remote areas, and in particular, for deployed forces in active military theaters such as Iraq and Afghanistan. Store-and-forward consultations are asynchronous exchanges of information, which may include recorded video of patient signs and symptoms, but most often involve exchange of static data (e.g., text, laboratory values, still images). Military teleneurology cases represent the spectrum of neurologic disorders and have also focused on management of nonpenetrating (e.g., concussive) traumatic brain injury. eConsultation requests are generated by the referring provider (medic or corpsman, physician assistant, nurse practitioner, or non-neurologist physician) via e-mail to a central account which is monitored and distributed to a group of neurologists for workup and treatment recommendations. This system allows a neurologic team to provide recommendations for treatment and also allows 2-way real-time communication with the provider to obtain additional clinical information. In addition to diagnosis and treatment recommendations, critical decisions such as whether to medically evacuate a service member for further evaluation and treatment could be expedited by telecommunication. For forward-deployed military forces, more efficient utilization of resources has been realized, and all but the most complicated cases are managed locally, avoiding the risk and cost of evacuating patients for routine neurologic consultation. From October 2006 to December 2010, deployed health care providers using the military's telemedicine system received 508 general neurologic and 131 traumatic brain injury (TBI) consultation requests, of which 482 (95%) originated in Iraq or Afghanistan.38 The most common diagnoses were migraine and other headaches (13%) and mild TBI (46%). For the majority of cases, consultants recommended local management. Eighty-four consultation requests resulted in recommendations ranging from routine to urgent or emergent medical evacuation, while 3 cases which were thought to require medical evacuation were able to be treated locally.38

AAN SUPPORT OF TELEMEDICINE

With more than 25,700 members, the American Academy of Neurology (AAN) is dedicated to promoting the highest quality patient-centered neurologic care. In March 2010, the AAN Board approved a policy position statement on stroke care recommending the availability of telemedicine services as an alternative for hospitals lacking critical elements for stroke care.39 It also endorses equitable reimbursement for care provided via telemedicine and the availability of telemedicine care similar to in-person on-call stroke-specific services. As a result of having a defined policy on stroke care that endorses telemedicine, the AAN will strongly advocate opportunities to find alignment of this position with pending legislation at the state and federal levels.

Several states have recently passed legislation acknowledging the role telemedicine provides in bridging coverage gaps. At the federal level, the 2010 Patient Protection and Affordable Care Act (ACA) contained provisions addressing health information technology.40 The following provisions in the ACA specifically address telemedicine services and are closely monitored by the AAN:

  • To find cost efficiencies for both programs, the new Center for Medicare and Medicaid Innovation (CMI) will examine new ways of delivering health care and paying health care providers. As a part of this charge, the CMI is mandated to study ways to improve the use of telemedicine services to treat behavioral health problems and stroke in medically underserved areas and facilities of the Indian Health Service.
  • The ACA also directs the CMI to consider delivery models that use technology, such as patient-based remote monitoring systems, to coordinate care over time and across settings.
  • Accountable Care Organizations will be able to fulfill the requirements to establish ways to promote evidence-based medicine and patient engagement, coordinate care, and report on quality and cost measures through the use of telemedicine, remote patient monitoring, and other such enabling technologies.

DISCUSSION

Current challenges in neurologic practice include 1) the growing burden of neurologic disease in our aging population, 2) disparities in and variation of neurologic services, 3) a shortage of neurologists to satisfy increasing demand, 4) the need for rapid expert evaluation and management of high-impact conditions including stroke, 5) addressing liability issues, and 6) adequate reimbursement. Telemedicine has demonstrated clinical effectiveness in increasing access to neurologic expertise, reducing patient and physician travel time, fostering communication and coordinated care, and improving physician productivity. As systems of care and technology evolve, the role of telemedicine in neurologic practice is uniquely positioned to add significant value with both improved outcomes and cost reduction as measurable goals.

GLOSSARY OF TERMS

eConsultation—a nonvisit electronic consultation between a requesting physician and a specialist. The eConsultation is typically requested through an online portal. This portal allows the requesting physician to ask a specific question and to upload supporting medical records or other data required for the specialist to provide an opinion. One of the goals of eConsultations is to provide timely access to a specialist's opinion, when there is a clear and focused question requiring a specialist's expertise and when a face-to-face examination is not required.

Hub-and-spoke system—a structure of telemedicine in which a certified comprehensive stroke center, usually in a large urban area, serves as the primary stroke center (the hub). The spokes are located in remote areas, usually smaller regional rural or underserviced hospitals. The neurology specialists at the hub will consult with doctors and people with neurologic symptoms at the remote sites (spokes).

Retail medicine—acute health care that is delivered in nontraditional settings, typically in high-traffic retail outlets associated with pharmacies like Wal-Mart or CVS. These settings may be referred to as “retail clinics” or convenient care clinics. Services are rendered by nurse practitioners or physician assistants on a walk-in basis.

Store-and-forward—the practice of telemedicine in which the initial care provider stores images or medical information and forwards them via e-mail to a specialist for review. Store-and-forward consultations typically occur at the specialist's convenience when the patient is not present.

Telemedicine—medical practice at a distance, or not in person, using modern communications technology. Such technology includes videoconferencing systems (real-time, synchronous) or store-and-forward systems (asynchronous, see “store-and-forward”). Subcategories (for the purposes of this article) include teleneurology, teleradiology, telestroke, and telerehabilitation.

ACKNOWLEDGMENT

The authors thank Jonathan P. Hosey, MD, FAAN, AAN Practice Committee Chair, for his support and guidance in orchestrating the development of the Telemedicine Work Group and for this contribution to the AAN. They also thank the American Academy of Neurology for its assistance in the preparation of this article.

GLOSSARY

AAN
American Academy of Neurology
ACA
Affordable Care Act
CMI
Center for Medicare and Medicaid Innovation
DBS
deep brain stimulation
IOM
intraoperative monitoring
TBI
traumatic brain injury
tPA
tissue plasminogen activator
VA
Veterans Affairs

AUTHOR CONTRIBUTIONS

Lawrence R. Wechsler: drafting/revising the manuscript, study concept or design. Jack W. Tsao: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, study supervision. Steven R. Levine: drafting/revising the manuscript, study concept or design, analysis or interpretation of data. Rebecca J. Swain-Eng: drafting/revising the manuscript. Robert J. Adams: drafting/revising the manuscript. Bart M. Demaerschalk: drafting/revising the manuscript. David C. Hess: drafting/revising the manuscript. Elena Moro: drafting/revising the manuscript. Lee H. Schwamm: drafting/revising the manuscript. Steve Steffensen: drafting/revising the manuscript. Barney J. Stern: drafting/revising the manuscript, study concept or design. Steven J. Zuckerman. drafting/revising the manuscript. Pratik Bhattcharya: drafting/revising the manuscript. Larry E. Davis: drafting/revising the manuscript, analysis or interpretation of data, contribution of vital reagents/tools/patients, acquisition of data. Ilana R. Yurkiewicz: drafting/revising the manuscript, analysis or interpretation of data. Aimee L. Alphonso: drafting/revising the manuscript.

DISCLOSURE

L. Wechsler has served as a consultant for Abbott Vascular, Lunbeck, and Ferrer; is on the Data and Safety Monitoring Board for DIAS 3/4/J and the steering committee for CLOSURE, ACT I; and owns stock in Neurointerventional Therapeutics. J. Tsao has received funding from the Telemedicine and Advanced Technology Research Center, United States Army, to develop a military neurology telemedicine system. S. Levine has given expert review and testimony on medical legal cases and has received research funding from the NIH. R. Swain-Eng is a full-time employee of the American Academy of Neurology. R.J. Adams is cofounder of REACHCall Inc., a for-profit telemedicine platform provider. He is also a co-owner of the company with <5% of outstanding stock. He is employed by Medical University of South Carolina, which offers telestroke consultation for fair market value to hospitals in South Carolina. He also is a speaker for Genentech, which makes tPA, but owns no stock. B. Demaerschalk has received telemedicine research grant funding from the Arizona Department of Health Services. Dr. Hess is a cofounder of REACHCall Inc., a for-profit telemedicine platform provider. He is also a co-owner of the company with <5% of outstanding stock. He is employed by Georgia Health Sciences University, which offers telestroke consultation for fair market value to hospitals in Georgia. He also has research contracts with Athersys, Inc., and Lundbeck. E. Moro has received honoraria from Medtronic for consulting services and speaking. She has received research grant support from St. Jude Medical and educational grants from Medtronic and St. Jude Medical. L. Schwamm serves as a consultant to LifeImage, a teleradiology company, and on the International Steering Committee for the DIAS3/4 trial. His employer, The Massachusetts General Hospital, offers an array of telehealth services at fair market value to many area hospitals, including telestroke. He has also given expert review and testimony on medical legal cases and has received research funding from the NIH on thrombolysis and HRSA on telemedicine. S. Steffensen reports no disclosures. B. Stern has received research support from Remedy Pharmaceuticals per patient research costs and research grants from the NIH. He has also received compensation for expert witness testimony. S. Zuckerman and P. Bhattacharya report no disclosures. L. Davis is a part of the VA Teleneurology group for which the VA pays part of the research costs for the nursing staff. I. Yurkiewicz and A. Alphonso report no disclosures. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy, the Department of Defense, or the Department of Veterans Affairs. Go to Neurology.org for full disclosures.

REFERENCES

1. American Association of Telemedicine. What is telemedicine and telehealth? http://www.americantelemed.org/files/public/abouttelemedicine/What_Is_Telemedicine.pdf Available at: . Accessed April 20, 2010.
2. Ganapathy K. Telemedicine and neurosciences. J Clin Neurosci 2005;12:851–862. [PubMed]
3. Ahmed SN, Mann C, Sinclair DB, et al. Feasibility of epilepsy follow-up care through telemedicine: a pilot study on the patient's perspective. Epilepsia 2008;49:573–585. [PubMed]
4. Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture: 2010 User Comparative Database Report: Table 3.1: Distribution of Database Hospitals and Respondents by Bed Size (Compared with AHA-Registered U.S. Hospitals). Rockville, MD: U.S. Department of Health and Human Services; 2010.
5. Capampangan DJ, Wellik KE, Bobrow BJ, et al. Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic. Neurologist 2009;15:163–166. [PubMed]
6. LaMonte MP, Bahouth MN, Hu P, et al. Telemedicine for acute stroke: triumphs and pitfalls. Stroke 2003;34:725–728. [PubMed]
7. Wiborg A, Widder B. Teleneurology to improve stroke care in rural areas: the Telemedicine in Stroke in Swabia (TESS) Project. Stroke 2003;34:2951–2956. [PubMed]
8. Moskowitz A, Chan YF, Bruns J, Levine SR. Emergency physician and stroke specialist beliefs and expectations regarding telestroke. Stroke 2010;41:805–809. [PMC free article] [PubMed]
9. Demaerschalk BM, Miley ML, Kiernan TE, et al. Stroke telemedicine. Mayo Clinic Proc 2009;84:53–64. [PMC free article] [PubMed]
10. Patterson V, Humphreys J, Henderson M, Crealey G. Email triage is an effective, efficient and safe way of managing new referrals to a neurologist. Qual Saf Health Care 2010;19:e51. [PubMed]
11. Harno K, Paavola T, Carlson C, Viikinkoski P. Patient referral by telemedicine: effectiveness and cost analysis of an Intranet system. J Telemed Telecare 2000;6:320–329. [PubMed]
12. Demaerschalk BM, Hwang HM, Leung G. Cost analysis review of stroke centers, telestroke, and rt-PA. Am J Manag Care 2010;16:537–544. [PubMed]
13. Schwamm LH, Pancioli A, Acker JE, III, et al. Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association's Task Force on the Development of Stroke Systems. Stroke 2005;36:690–703. [PubMed]
14. Levine SR, Gorman M. "Telestroke": the application of telemedicine for stroke. Stroke 1999;30:464–469. [PubMed]
15. Shafqat S, Kvedar JC, Guanci MM, Chang Y, Schwamm LH. Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale. Stroke 1999;30:2141–2145. [PubMed]
16. Schwamm LH, Rosenthal ES, Hirshberg A, et al. Virtual TeleStroke support for the emergency department evaluation of acute stroke. Acad Emerg Med 2004;11:1193–1197. [PubMed]
17. Miley ML, Demaerschalk BM, Olmstead NL, et al. The state of emergency stroke resources and care in rural Arizona: a platform for telemedicine. Telemed J E Health 2009;15:691–699. [PubMed]
18. LaMonte MP, Cullen J, Gagliano DM, et al. TeleBAT: mobile telemedicine for the Brain Attack Team. J Stroke Cerebrovasc Dis 2000;9:128–135. [PubMed]
19. Lai JC, Woo J, Hui E, Chan WM. Telerehabilitation: a new model for community-based stroke rehabilitation. J Telemed Telecare 2004;10:199–205. [PubMed]
20. Vespa PM, Miller C, Hu X, Nenov V, Buxey F, Martin NA. Intensive care unit robotic telepresence facilitates rapid physician response to unstable patients and decreased cost in neurointensive care. Surg Neurol 2007;67:331–337. [PubMed]
21. Switzer JA, Hall CE, Close B, et al. A telestroke network enhances recruitment into acute stroke clinical trials. Stroke 2010;41:566–569. [PubMed]
22. Samii A, Ryan-Dykes P, Tsukuda RA, Zink C, Franks R, Nichol WP. Telemedicine for delivery of health care in Parkinson's disease. J Telemed Telecare 2006;12:16–18. [PubMed]
23. Loh PK. Telemedicine and Alzheimer's disease from studio-based videoconferencing to mobile handheld cell phones. J Brain Dis 2009;1:39–43. [PMC free article] [PubMed]
24. Qaddoumi I, Mansour A, Musharbash A, et al. Impact of telemedicine on pediatric neuro-oncology in a developing country: the Jordanian-Canadian experience. Pediatr Blood Cancer 2007;48:39–43. [PubMed]
25. Terry JB. Evolution of neuronetworks. Neuroepidemiology 2000;19:20–29. [PubMed]
26. Cottrell C, Drew J, Gibson J, Holroyd K, O'Donnell F. Feasibility assessment of telephone-administered behavioral treatment for adolescent migraine. Headache 2007;47:1293–1302. [PMC free article] [PubMed]
27. Kane RL, Bever CT, Ehrmantraut M, Forte A, Culpepper WJ, Wallin MT. Teleneurology in patients with multiple sclerosis: EDSS ratings derived remotely and from hands-on examination. J Telemed Telecare 2008;14:190–194. [PubMed]
28. Mendez I, Hill R, Clarke D, Kolyvas G, Walling S. Robotic long-distance telementoring in neurosurgery. Neurosurgery 2005;56:434–440. [PubMed]
29. Hutarew G, Schlicker HU, Idriceanu C, Strasser F, Dietze O. Four years experience with teleneuropathology. J Telemed Telecare 2006;12:387–391. [PubMed]
30. Paing WW, Weller RA, Welsh B, Foster T, Birnkrant JM, Weller EB. Telemedicine in children and adolescents. Curr Psychiatry Rep 2009;11:114–119. [PubMed]
31. Thomas EJ, Lucke JF, Wueste L, Weavind L, Patel B. Association of telemedicine for remote monitoring of intensive care patients with mortality, complications, and length of stay. JAMA 2009;302:2671–2678. [PubMed]
32. Barbe M, Liebhart L, Runge M, et al. Deep brain stimulation in the nucleus ventralis intermedius in patients with essential tremor: habituation of tremor suppression. J Neurol 2011;258:434–439. [PubMed]
33. Walter U, Wolters A, Wittstock M, et al. Deep brain stimulation in dystonia: sonographic monitoring of electrode placement into the globus pallidus internus. Mov Disord 2009;24:1538–1541. [PubMed]
34. Arle JE, Shils JL. Neurosurgical decision-making with IOM: DBS surgery. Neurophysiol Clin 2007;37:449–455. [PubMed]
35. Craig JJ, McConville JP, Patterson VH, Wootton R. Neurological examination is possible using telemedicine. J Telemed Telecare 1999;5:177–181. [PubMed]
36. Rasmusson KA, Hartshorn JC. A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic. Epilepsia 2005;5:767–770. [PubMed]
37. Bloch C. Federal Agencies: Activities in Telemedicine, Telehealth, and Health Technology. St. Charles, MO: B.C. Group; 2010.
38. Yurkiewicz IR, Lappan CM, Neely ET, et al. Outcomes from a US military neurology and traumatic brain injury telemedicine program. Neurology 2012;79:1237–1243. [PubMed]
39. American Academy of Neurology Position Statement on Stroke Care. Available at: http://www.aan.com/advocacy/issues/tools/167.pdf. Accessed November 28, 2011.
40. Association AT Telemedicine in U.S. National Health Reform: 2010. Available at: http://www.americantelemed.org/files/public/policy/Telemedicine%20in%20National%20Health%20Reform.pdf. Accessed January 10, 2011.

Articles from Neurology are provided here courtesy of American Academy of Neurology