Neurology and COVID-19: instant practice adaptation with little data for guidance

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has taken the world by storm. The global medical system has been overwhelmed by the rapidity of the virus’ spread and its severity. Although it primarily affects the respiratory system, COVID-19 can also impact patients with neurologic conditions.

What role does telehealth medicine play in the outpatient care of MS patients?

The concept of “social distancing” has become synonymous with COVID-19 and is being applied to neurology outpatient clinics, too. Risk of infection from clinic visits is reduced to zero when patients use a smartphone or tablet in their home or workplace. Neurologic disorders are particularly well-suited for telehealth medicine; examination is important when making an initial diagnosis, but for most conditions, it becomes much less crucial during follow-up visits for established disease. As a result, effective follow-up visits can be conducted virtually (online), but both providers and patients are required to have access to equivalent platforms. Previously, telehealth required HIPAA-compliant platforms, which included Zoom for Healthcare, Skype for Business, MyChart through Epic, and Updox. These platforms can be expensive for healthcare organizations to license and operate and also require training for providers and patients. In response to the COVID-19 crisis, on March 19, 2020, the US Department of Health & Human Services announced “enforcement discretion” and stated that it will not impose penalties for noncompliance with HIPAA regulatory requirements. It specifically allowed providers to use Apple FaceTime, Facebook Messenger video chat, Google Hangouts video chat, and Skype video chat to conduct telehealth visits. At the Cleveland Clinic, all providers were strongly encouraged to shift outpatient visits from in-person to virtual visits. By March 20, more than 90% of outpatient visits at the Mellen Center for Multiple Sclerosis were being conducted virtually, and all open future outpatient visits at the center had been converted to virtual visits. Telehealth platforms sometimes had insufficient bandwidth, so plain telephone was used as a fallback.