Telemedicine or telehealth has been described as a path to virtual integrated care and is changing health care delivery in communities across the United States (US). The use of telehealth in hospitals has grown rapidly from 35% in 2010 to 76% in 2017, connecting patients to vital health care services with consulting practitioners at a distance through videoconferencing, remote monitoring, electronic consults, and wireless communications. In fact, recent years have seen significant use in telehealth; more than half the hospitals in the US have implemented remote patient monitoring capabilities.
One area in which telehealth is rapidly expanding access is in chronic care management, such as seizure disorders. In 2015, 1.2% of the US population had active epilepsy—3 million adults and 470,000 children. Although electroencephalograms (EEGs) are used for many areas of neurology, they are particularly critical in the diagnosis of seizures and epilepsy. EEG findings contribute to the multi-axial diagnosis of epilepsy in terms of whether the seizure disorder is focal or generalized, idiopathic or symptomatic, or part of a specific epilepsy syndrome. In addition to confirming and classifying seizure disorders, intracranial EEG monitoring is also useful in planning surgeries for some patients.
While many rural hospitals are equipped with EEG equipment, few are staffed with knowledgeable neurologists who can interpret the results to effectively manage patients with seizures. In fact, EEGs are very often misinterpreted by inexperienced readers. Specifically, EEGs tend to be “over-read” as abnormal when they are normal, resulting in wrong diagnoses of seizures and epilepsy. And while many hospitals, rural, remote, and urban, may have neurology departments, they often cannot justify retaining staff neurologists.
The use of teleneurology services in rural hospitals for stroke management is well established and may offer a framework for the expansion of tele-EEG services for patients in the Emergency Department or Critical Care Units who have altered mental status with a suspicion of non-convulsive seizure activity. Access to both experienced EEG technologists to monitor patients and trained epileptologists or neurophysiologists to read EEG records in near real-time is key to managing patients onsite and avoiding the complication and cost of transferring patients to other facilities, which in many cases are hours away. A study covering 24 acute care hospitals in a tri-state area including 5 Critical Access Hospitals, found that the need for critical care and neurology services were the two top reasons for transfers, accounting for nearly 54% of cases.
A recent report from the Telemedicine Work Group of the American Academy of Neurology, states, “Ample evidence in the literature supports the successful use of teleneurology for PWE (people with epilepsy).” Furthermore, the report sites a comparison study where teleneurology consults were provided to one of two rural hospitals, with the patients in the hospital receiving remote consults experiencing, “…significantly shorter stays without any difference in diagnosis, mortality or use of inpatient hospital resources or medical services in the follow-up period…”
CortiCare®, started in 2012, is the first and one of the largest tele-EEG services in the US with over 55 registered EEG technologists and more than 50 board-certified neurophysiologists. Tele-neurology, such as provided by CortiCare’s Nationwide Neurophysiologist Network, can provide EEG reading and consulting services for seizure management to facilities that lack local EEG expertise.
CortiCare delivers an innovative, remote-based tele-EEG solution with real-time monitoring and reading services for healthcare facilities worldwide. Whether you need 24×7 remote monitoring or gap coverage, CortiCare has the team to help you provide the best care to your neurologically compromised patients.
From the ICU and NICU to the ED and EMU, CortiCare offers the only nationwide network of remote EEG monitoring and reading services for long-term, stat, and routine EEG studies. Our board-certified neurophysiologists and epileptologists, along with our team of Registered EEG technologists, can see up-to- the-second patient brain activity and interpret potential seizure risks.
In addition, CortiCare can deliver multi-day, in-home ambulatory video-EEG recordings include remote, real-time monitoring patient studies, which ensures quality recordings with excellent clinical yield, potentially higher likelihood of capturing epileptic events in the home environment, elimination of the need for patients and families to travel to hospitals for testing, quicker access to services, better tolerability of ambulatory video-EEG procedures than inpatient procedures, and lower cost of at-home service than a stay in a hospital Epilepsy Monitoring Unit.
CortiCare is a new wave of EEG services, providing an innovative remote-based tele-EEG solution that delivers real-time monitoring and reading services to hospitals and private practices, making brain monitoring services easy anytime and anywhere.
References
American Hospital Association. Fact Sheet Telehealth. https://www.aha.org/system/files/2019-02/fact-sheet-telehealth-2-4-19.pdf
American Hospital Association. Innovation Market Insights. Telehealth. https://www.aha.org/system/files/media/file/2019/02/MarketInsights_TeleHealthReport.pdf
Centers for Disease Control and Prevention. Epilepsy Data and Statistics. https://www.cdc.gov/epilepsy/data/index.html
Chen H, Koubeissi MZ. Electroencephalography in Epilepsy Evaluation. Continuum (Minneap Minn). 2019 Apr;25(2):431-453. doi: 10.1212/CON.0000000000000705
Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry. 2005;76 Suppl 2(Suppl 2):ii2‐ii7. doi:10.1136/jnnp.2005.069245
Benbadis SR, Tatum WO. Over-interpretation of EEGs and misdiagnosis of epilepsy. J Clin Neurophysiology 2003;20:42-44.
Sharpe C, Davis SL, Reiner GE, et al. Assessing the Feasibility of Providing a Real-Time Response to Seizures Detected With Continuous Long-Term Neonatal Electroencephalography Monitoring. J Clin Neurophysiol. 2019;36(1):9‐13. doi:10.1097/WNP.0000000000000525
Nair, Dilip; Gibbs, Mary M. “Inter-hospital transfers from rural hospitals to an academic medical center.” The Free Library 01 July 2013. Accessed 18 June 2020 <https://www.thefreelibrary.com/Inter-hospital transfers from rural hospitals to an academic medical…-a0339117967>.
Jaime M. Hatcher-Martin, MD, PhD, Jamie Lynn Adams, MD, Eric R. Anderson, MD, PhD, et al. Telemedicine Work Group of the American Academy of Neurology update. Neurology 2020;94:30-38. doi:10.1212/WNL.0000000000008708
