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Neurosurgical spine care during COVID-19 pandemic: The Department of Neurological Surgery Houston Methodist experience
Introduction
Telemedicine has traditionally been utilized for remote consultations in areas of medicine such as trauma, neurology, and psychiatry. However, with the 2020 COVID-19 pandemic, multiple disciplines of medicine quickly learned the utility of this modality of providing health care to our patients. This became necessary in order to deliver health care during this pandemic while reducing staff exposure to ill persons, reducing the burden of cases, as well as preserving personal protective equipment. Although this presented some challenges, namely changing some of our traditional ways of assessing patients, we saw this as a great opportunity not only to learn, but also to continue to provide neurosurgical spine care to our existing patients as well as to offer health care to new patients.
Our approach
The approach began with communicating to our established patients that continuity of care was available through telemedicine. The referring physicians were made aware of our capacity to offer telemedicine evaluation to new patients. Prior to the pandemic, a physician had to be licensed in the state where the patient was located; however, waivers were put in place to allow physicians to serve some patients out of state. We did not face this situation, as most of our patients remained in the state of Texas. The process also was easier to implement immediately as non-Health Insurance Portability and Accountability Act (HIPPA)-compliant modes of communication, such as FaceTime, became permissible. Hence, the option was given to the patient to communicate via video teleconferencing, including FaceTime, telephone only, or electronic communication such as email. Almost unanimously, our patient population elected for video teleconferencing, and we used HIPPA-compliant teleconferencing means of communication, using electronic privacy information center (EPIC) electronic medical record (Verona, Wisconsin). Only on the rare occasion of being unable to connect, after multiple attempts, did we conduct the evaluation via telephone. We did not find it necessary ever to employ electronic communication by way of email or medical record messaging, except for sending out and receiving new patient packet information. Once the patient was scheduled for a visit, the workflow essentially followed the same pattern as for our face-to-face inpatient visits.
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