Teleneurology Expansion in Response to the COVID-19 Outbreak at a Tertiary Health System in New York City

Objective To assess the implementation of teleneurology (TN), including patient and clinician experiences, during the coronavirus respiratory disease 2019 (COVID19) pandemic. Methods We studied synchronous (video visit) and asynchronous (store-and-forward, patient-portal evaluation, remote monitoring) TN utilization in the Mount Sinai Health System Neurology Department in New York, 2 months before and after the start of our department9s response to the pandemic in mid-March 2020. Weekly division meetings enabled ongoing assessments and analysis of barriers and facilitators according to the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change models. We used post-visit surveys of clinicians (from April 13 to May 15, 2020) and patients (from May 11 to 15, 2020) to determine technology platforms used, and TN experience and acceptability, using Likert scales (1 = very poor/unlikely to 5 = very good/likely). Results Over the 4-month period, 117 TN clinicians (n = 14 subspecialties) conducted 4,225 TN visits with 3,717 patients (52 pre-vs 4,173 post-COVID19). No asynchronous TN services were delivered. Post-COVID19, the number of TN clinicians, subspecialties performing TN, and visits increased by 963%, 133%, and 7,925%, respectively. Mean acceptability among patients and clinicians was 4.7 (SD 0.6) and 3.4 (SD 1.6), respectively. Most video visits were completed using Epic MyChart (78.5%), and Zoom (8.1%). TN implementation facilitators included Medicare geographic restriction waivers, development of clinician educational materials, and MyChart outreach programs for patients experiencing technical difficulties. Conclusions A significant expansion of TN utilization accompanied the COVID19 response. Patients found TN more acceptable than did clinicians. Proactive application of an implementation framework facilitated rapid and effective TN expansion.