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      Telemedicine in the era of COVID-19: a neurosurgical perspective


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          Despite the substantial growth of telemedicine and the evidence of its advantages, utilization of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the COVID-19 pandemic has limited typical evaluation of patients with neurological issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients’ perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuro exam. However, we argue that an accurate and comprehensive neurologic exam can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. Additionally, certain neurosurgical visits such as post-operative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.

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          Author and article information

          World Neurosurg
          World Neurosurg
          World Neurosurgery
          Elsevier Inc.
          16 May 2020
          16 May 2020
          [1 ]Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA
          Author notes
          []Address correspondence to: Rachel Blue MD Department of Neurosurgery 3rd Floor, Silverstein Pavilion University of Pennsylvania 3400 Spruce Street Philadelphia, PA 19104
          © 2020 Elsevier Inc. All rights reserved.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          : 29 April 2020
          : 6 May 2020
          : 7 May 2020

          telehealth,telemedicine,covd-19,clinic,neurologic examination


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