Teleneurology, while a potentially effective route in delivering quality neurological care to remote patients, remains unregulated in medical education. In response, a researcher from the University of Missouri School of Medicine and a team at the American Academy of Neurology (AAN) developed a teleneurology curriculum.

The curriculum, explained in Neurology, was developed by a team of 12 AAN specialists and lead author Raghav Govindarajan, MD, assistant professor of clinical neurology at the MU School of Medicine. The team compiled the curriculum into five main areas of understanding for medical students, resident physicians, fellows and other healthcare provider in both the academic and private medicine practice.

“We’re facing a shortage of neurologists in both rural and urban areas, compounded by the fact that more patients now have insurance and are able to seek care,” said Govindarajan. “Through teleneurology, we’re able to virtually treat patients using technologies such as two-way video conferencing, wireless sensors, and text- and image-based communication. This has shown tremendous promise and has already played a major role in acute stroke care. Despite this, teleneurology training in residency programs is currently non-existent, or it is sporadic and inconsistent at best.”

The five points in the curriculum needed to understand teleneurology include:

1. Introduction to technology, basic implementation and limitations: Providers must develop a strong foundation of technical knowledge in patients’ medical records, cameras and other functions to efficiently run the programs needed to conduct teleneurology visits.
2. Licensure, medical legal issues and ethics: Providers must have an understanding of the differing licensing requirements by state to avoid potential legal trouble.
3. “Webside” manners: Providers must learn how to connect with patients though a screen and learn how to maintain the patient-provider relationship without the chance for face-to-face visits.
4. Informed consent, patient privacy and disclosure: Providers must inform patients about the privacy and security of their data in accordance with the Health Insurance Portability and Accountability Act and the Health Information Technology for Economic and Clinical Health Act.
5. Neurology-specific clinical skills: Provides must explain expectations to patients to ensure health concerns are addressed as efficiently as in-person visits.

“Unfortunately, teleneurology is akin to the Wild West,” Govindarajan said. “Many practitioners may be operating without the necessary skills and expertise to best care for patients. They’re putting their patients and themselves at unnecessary risk. Our outline for a teleneurology curriculum is meant to be an evolving document that will continue to be adapted to best practices in the field. It’s our hope that it will be implemented at organizations across the country and internationally.”