Neuromuscular evaluation

The history of telemedicine

Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. However, this simple definition does not reflect the history of its development, which has been integrated with technology, and innovation. Like many technological advances that are now common to our daily lives and professions, telemedicine was birthed alongside the birth and growth of the internet in the 1960s. One of its earliest uses in medicine was the use of the satellite ‘Early Bird’ which allowed Dr Michael Debakey to conduct an aortic valve replacement while engaging with surgeons in the Director-General of the WHO and other surgeons in Geneva Switzerland. Fast forward to 2020, and the marriage of the internet and technology has created a diverse and broad telecommunication platform accessible not only to governments, world organizations, and institutions, but also to civilians, from the clinician and systems-based providers to the individual health care consumer.

Telemedicine in neurology

However, it was the use of telemedicine in stroke care that actually paved the way for the application of telemedicine in neurology practice settings. Telestroke services have been an essential part of acute stroke care for more than a decade, integrated with improved access, quality of care, and treatment rates with evidence of equitable outcomes. Until recently, with the advent of the COVID-19 pandemic, the advances witnessed with telestroke services have been limited in use for other neurological conditions.

Prior to the COVID-19 pandemic and its impact on society, and more specifically the delivery of quality health care, discussion of telemedicine use in neurology was limited to a minority of ambulatory practices with great variability in how it was used among clinicians and their practices. Most publications discussed the potential of telemedicine across different subspecialties and approaches to delivery, from multidisciplinary care clinics to rural isolated practices. Most publications reported noninferiority of telemedicine evaluations to in-person evaluations in regards to disease outcomes as well as patient and clinician satisfaction related to increased access, decreased travel, and costs per visit. Yet there has been minimal evidence showing utility across various settings and cultures, and even less evidence regarding its impact upon clinical outcomes in large cohorts, including that of neuromuscular medicine.