Remote Neurology Coverage for New England Hospitals
Explore This Program
Since 2000, Mass General TeleNeurology has been expanding from a small pilot on Martha’s Vineyard to one of the largest academic TeleNeurology networks in the nation. 6.5 million New Englanders have access to a neurologist through the 35 programs at 23 Mass General TeleNeurology hospitals in their counties. Additionally, Mass General Neurology patients can often conduct their follow up appointments from their homes or workplaces.
- Mass General TeleStroke has increased use of thrombolytics to 9x+ the national average while avoiding unnecessary and costly inter-hospital transfers in 70%+ of consults.
- This suggests more than $6 million in potential reimbursements for community centers.
- More recently, Non-acute TeleNeurology, which is growing at a rapid rate, has allowed 95%+ inpatient retention, again avoiding high cost transfers and keeping care local.
Our remote TeleNeurology clinical services are classified in two groups: those covering the hospital setting and those covering the outpatient setting, such as a primary care practice. Hospital services require dedicated telemedicine endpoints as well as a radiology image transfer technology, and can be Emergent, like TeleStroke, or non Emergent, like inpatient TeleNeurology.
On the other hand, our General and Subspecialty Outpatient TeleNeurology service provides access to primary care practices affiliated with our community hospital members. This service does not require dedicated telemedicine endpoints or radiology transfer connections. It relies on mostly scheduled virtual clinics that minimize the disruption on local primary care provider workflows.
Emergency TeleNeurology and TeleStroke
Our emergency TeleNeurology and TeleStroke services provide 24/7 access within 5 minutes to an emergency neurologist or stroke specialist. Typical conditions includes stroke, hemorrhage, status epilepticus, comas, chord compressions, Guillain-Barre, and acute non-traumatic weakness.
How does Emergency TeleNeurology or TeleStroke work?
When a patient with stroke or neurology symptoms is in need of emergent care, your team pushes the patient’s imaging studies and pages the on-call TeleNeurology specialist for a consultation.
- Case Review
The TeleNeurology specialist immediately begins the assessment of the images and returns the page by phone to review the case; the consult may transition to a videoconference call, if appropriate. Using the video connection, the specialist will review the patient’s presentation with your emergency department physician and, aided by your local staff, will perform a neurological assessment.
- Online Assessment
The TeleNeurology specialist documents the information within the TeleNeurology Web Portal. You can access the portal to retrieve your local EMR or have it sent via fax.
- Collaborative Decision Making
Upon completion of the examination, the findings will be discussed with your team. Together you will decide on a plan of care.
Routine Hospital TeleNeurology
For non-emergent conditions, we provide same business day connections to a general neurologist. Typical conditions for routine TeleNeurology consultations include headache, sub-acute stroke, encephalopathy, vertigo, weakness, cognitive changes, and seizure.
Our TeleEEG service provides remote interpretation of inpatient and outpatient EEG studies. The EEG is ordered by the patient’s local provider and performed by technologists onsite, then interpreted, usually on the same business day, by a Mass General Clinical Neurophysiology fellow. A final report by a faculty level physician is made available shortly after. For emergency EEG cases, the requesting hospital works with TeleNeurology to establish pathways for STAT and urgent tests.
Outpatient and Multi-subspecialty Access
Outpatient TeleNeurology services provide same-day access during business hours to a general or subspecialty neurologist. We work with you to adapt our resources to your primary care practice’s processes through mutually convenient virtual clinic sessions that minimize the time demand for the local physician, and to enable continuity of care for common chronic diseases, like movement or memory disorders.
Our implementation process is streamlined to ensure you have the appropriate technology and training to effectively serve your patients. Our program will guide you through every step of the process and will ensure you have the clarity and information you need to move forward swiftly. Once your local medical and technical champions have been identified, and deployed and tested your technologies, we conduct three carefully designed training sessions to ensure the comfort of your staff. With our clinical and technical support processes, your staff will have the confidence to accurately and safely treat your patients. During our last training session, we will simulate a real video consult from request to patient examination. After go-live our teams continue to work together to carefully screen and identify areas for continuous improvement.
The implementation of Emergency TeleNeurology takes an estimated two to three months.
Comprehensive Hospital TeleNeurology (Emergencies and Non-Emergencies)
Comprehensive TeleNeurology implementations may require additional time to ensure you are well prepared to utilize both emergency and non-emergency processes. Our comprehensive offering also usually involves distinct clinical champions for each care setting (ED, ICU, and Ward) and a higher number of credentialed Mass General TeleNeurologists.
The implementation of comprehensive Hospital TeleNeurology takes an estimated two to four months.
General and Subspecialty (Outpatient Teleneurology)
Setting up a facility for General and Subspecialty Outpatient TeleNeurology services is simpler in terms of technology deployment, as most consults are performed on office computers, laptops or tablets. Thorough testing is conducting with the primary care practice to ensure the reliability of wireless signals for the mobile devices. Radiology image transfers can occur through the associated hospital’s radiology department (as for hospital TeleNeurology) or directly from the practice through radiology CDs. The clinical and administrative staff is then trained on the use of the systems- the video system, the Mass General TeleHealth portal as well as in the Mass General Outpatient TeleNeurology processes. Our final phase of training includes a mock drill with the providers and a stand in patient, conducting a consult from start to finish.
The implementation timeline for Outpatient TeleNeurology services takes an estimated one to two months.
The TeleNeurology Program provides our partners with quarterly check-ins, including a yearly site visit. During these check-ins, we jointly and collaboratively review:
- Utilization of the program: the types and number of consults requested, tPA treatment rates and review opportunities to increase the rate of patient retention, if that’s among the goals of the local team
- Updates to the program
- Technical checks and reviews
- Gather feedback from the site and develop plans for continued success
- During the site visit we tour the hospital and meet established and new staff, increase awareness and answer questions about the program
We also conduct detailed stroke operations “Gap analyses” for new partners, to identify opportunities to strengthen the local stroke operation. Additionally, Mass General TeleNeurology openly shares clinical guidelines, screening tools and a wealth of top quality clinical information.
Through these efforts, our program has also been instrumental in supporting our network community hospitals in attaining local, state or national recognition for their achievements in stroke care. 100% of our Massachusetts sites are DPH certified stroke centers and 50% of all of our partners have obtained Silver, Silver Plus, Gold or Gold Plus certifications with the American Heart Association/American Stroke Association, Get With The Guidelines program. Many of the remaining hospitals in our network are certified as advanced primary stroke centers by Det Norske Verita (DNV). Along these lines, we promote efforts to improve quality, for example by working to decrease door to needle times network-wide, by analyzing data for our partners and sharing individualized, actionable recommendations. Other quality initiatives we have implemented include 90 day follow up modified Rankin Scales on patients who receive IV tPA and remain at their community hospital, as well as monitoring our own TeleNeurology report completion times to ensure vital information such as treatment recommendations, sub-acute care and secondary prevention measures are available in a timely manner.
Our team members are personally available to our partner teams to answer questions, provide follow up and review cases on an ad hoc basis. It’s our commitment to support our partners’ efforts to continuously improve their performance. Close, mutually respectful and sustainable relationships lay at the very core of what makes us successful.
Mass General TeleNeurology is focused on enhancing the educational opportunities available to our partners, thereby increasing and supporting the improved identification and care of stroke and general neurology patients. To this end, we offer a web-based educational program, hosted by Harvard Medical School. Our series of cerebrovascular and general neurology lectures are CME and CNE eligible, and can be accessed from a computer or mobile device anytime, anywhere. Our speakers are world renowned Mass General physicians and nurses and many are Harvard Medical School faculty members. In parallel, we also offer ad-hoc onsite CME lectures from these same faculty members, with topics ranging from the signs and symptoms of an acute ischemic stroke to cutting-edge endovascular therapies.