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      Survey of Telehealth Adoption by Neuro-ophthalmologists During the COVID-19 Pandemic: Benefits, Barriers, and Utility

      research-article
      , MD, PhD, , MD, , MD
      Journal of Neuro-Ophthalmology
      Journal of Neuro-Ophthalmology

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          Abstract

          Supplemental Digital Content is Available in the Text.

          Abstract

          Background:

          During the COVID-19 pandemic, telehealth modalities have come to prominence as a strategy for providing patient care when in-person care provision opportunities are limited. The degree of adoption by neuro-ophthalmologists has not been quantified.

          Methods:

          Telehealth utilization pre–COVID-19 and peri–COVID-19 was surveyed among practicing neuro-ophthalmologists in and outside the United States using an online platform. Demographics, perceived benefits, barriers, and utility for different neuro-ophthalmic conditions were collected. Data collection occurred over a 2-week period in May 2020.

          Results:

          Two hundred eight practicing neuro-ophthalmologists (81.3% United States, 50.2% females, age range <35 to >65, mode 35–44 years) participated in the survey. Utilization of all telehealth modalities increased from pre-COVID to peri-COVID (video visit 3.9%–68.3%, P < 0.0005, remote interpretation of testing 26.7%–32.2%, P = 0.09, online second opinion 7.9%–15.3%, P = 0.001, and interprofessional e-consult 4.4%–18.7%, P < 0.0005, McNemar). The majority selected access, continuity, and patient efficiency of care as benefits and data quality as a barrier. Telehealth was felt to be most helpful for conditions relying on history, external examination, and previously collected ancillary testing and not helpful for conditions requiring funduscopic examination.

          Conclusions:

          Telehealth modality usage by neuro-ophthalmologists increased during the COVID-19 pandemic. Identified benefits have relevance both during and beyond COVID-19. Further work is needed to address barriers in their current and future states to maintain these modalities as viable care delivery options.

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          Most cited references10

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          Telehealth Transformation: COVID-19 and the rise of Virtual Care

          Abstract The novel coronavirus disease-19 (COVID-19) pandemic has altered our economy, society and healthcare system. While this crisis has presented the US healthcare delivery system with unprecedented challenges, the pandemic has catalyzed rapid adoption of telehealth or the entire spectrum of activities used to deliver care at a distance. Using examples reported by US healthcare organizations including ours, we describe the role telehealth has played in transforming healthcare delivery during the three phases of the US COVID-19 pandemic: 1) Stay-at-Home Outpatient Care; 2) Initial COVID-19 Hospital Surge, and 3) Post-Pandemic Recovery. Within each of these three phases, we examine how people, process and technology work together to support a successful telehealth transformation. Whether healthcare enterprises are ready or not, the new reality is that virtual care has arrived.
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            COVID-19 transforms health care through telemedicine: evidence from the field

            Abstract This study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and non-urgent health care delivery from one large health system (NYU Langone Health) at the epicenter of the COVID-19 outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 369.1 daily to 866.8 daily (135% increase) in urgent care after the system-wide expansion of virtual health visits in response to COVID-19, and from 94.7 daily to 4209.3 (4345% increase) in non-urgent care post expansion. Of all virtual visits post expansion, 56.2% and 17.6% urgent and non-urgent visits, respectively, were COVID-19-related. Telemedicine usage was highest by patients aged 20-44, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and non-urgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate.
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              Virtual Ophthalmology: Telemedicine in a Covid-19 Era

              Purpose To discuss the effects of the SARS-Cov-2 betacoronavirus on ambulatory ophthalmology practices, the value proposition of telemedicine, tele-ophthalmology implementation methodologies, and the accelerated future of telemedicine. Design Review of the current telehealth landscape including usage, policies, and techniques for ambulatory practice integration. Methods We provide author-initiated review of recent trends in telehealth, governmental recommendations for healthcare delivery during the COVID-19 pandemic, and a PubMed Central query for telemedicine in ophthalmology or tele-ophthalmology. In addition, authors’ comprehensive experience in telemedicine design and implementation is provided. Results A summary describing the present state of telehealth, tele-ophthalmology modeling, care delivery, and the proposed impact of telehealth surges on the future of ophthalmology practice. Conclusion Recent patient and provider interest in telemedicine, the relaxation of regulatory restrictions, increased remote care reimbursement, and ongoing social distancing practices compels many ophthalmologists to consider virtualizing services.
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                Author and article information

                Journal
                J Neuroophthalmol
                J Neuroophthalmol
                jno
                Journal of Neuro-Ophthalmology
                Journal of Neuro-Ophthalmology
                1070-8022
                1536-5166
                07 July 2020
                : 10.1097/WNO.0000000000001051
                Affiliations
                Departments of Ophthalmology (HEM) and Neurology & Neurological Sciences (HEM), Stanford University, Palo Alto, California; Department of Ophthalmology (KEL, MWK), Indiana University School of Medicine, Indianapolis, Indiana; Ophthalmology Service (KEL), Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana; and Departments of Neurology and Neurosurgery (MWK), Indiana University School of Medicine, Indianapolis, Indiana.
                Author notes
                Address correspondence to Melissa W. Ko, MD, Departments of Neurology. Ophthalmology and Neurosurgery, Indiana University School of Medicine, IU Health Neurosciences Center, 355 W. 16th Street, Indianapolis, IN 46202; E-mail: melko@ 123456iu.edu
                Article
                JNO-D-20-00316
                10.1097/WNO.0000000000001051
                7382419
                32639269
                57733488-87a6-4e9f-88a7-a207a2188775
                Copyright © 2020 by North American Neuro-Ophthalmology Society

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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