Telemedicine review in neuro-oncology: comparative experiential analysis for Barrow Neurological Institute and Geisinger Health during the 2020 COVID-19 pandemic

Abstract

Coronavirus disease 2019 (COVID-19) has grossly affected how we deliver health care and how health care institutions derive value from the care provided. Adapting to new technologies and reimbursement patterns were challenges that had to be met by the institutions while patients struggled with decisions to prioritize concerns and to identify new pathways to care. With the implementation of social distancing practices, telemedicine plays an increasing role in patient care delivery, particularly in the field of neurology. This is of particular concern in our cancer patient population given that these patients are often at increased infectious risk on immunosuppressive therapies and often have mobility limitations. We reviewed telemedicine practices in neurology pre- and post-COVID-19 and evaluated the neuro-oncology clinical practice approaches of 2 large care systems, Barrow Neurological Institute and Geisinger Health. Practice metrics were collected for impact on clinic volumes, institutional recovery techniques, and task force development to address COVID-19 specific issues. Neuro-Oncology divisions reached 67% or more of prepandemic capacity (patient visits and slot utilization) within 3 weeks and returned to 90% or greater capacity within 6 weeks of initial closures due to COVID-19. The 2 health systems rapidly and effectively implemented telehealth practices to recover patient volumes. Although telemedicine will not replace the in-person clinical visit, telemedicine will likely continue to be an integral part of neuro-oncologic care. Telemedicine has potential for expanding access in remote areas and provides a convenient alternative to patients with limited mobility, transportation, or other socioeconomic complexities that otherwise challenge patient visit adherence.

Keywords: Barrow Neurological Institute (BNI); COVID-19; Geisinger Health; neuro-oncology; telehealth.

Figure 1.

Flow Diagram of Barrow Neurological Institute Telemedicine Task Force Assigned to Develop a System of Telemedicine Office Visits.

Figure 2.

Comparative Analysis of Clinic Slot Utilization for Barrow Neurological Institute vs Geisinger Health Neuro-Oncology Ambulatory Clinics. The neuro-oncology clinic COVID-19 analysis period between March 16, 2020 to May 2, 2020 (within the gray-shaded rectangle). Neuro-oncology clinic utilization rates for Barrow (blue line) vs Geisinger (orange line) between July 2019 and May 2020. Maximum decline in utilization seen in early April was at 67% (Barrow) and 84% (Geisinger). State closure dates for Barrow/Arizona (blue vertical dashed-line) March 15, 2020 vs Geisinger/Pennsylvania (orange vertical dashed-line) March 5, 2020. State initial reopening dates Barrow/Arizona (blue up arrow) April 15, 2020 vs Geisinger/Pennsylvania (orange up arrow) April 27, 2020. (Dates of closure and reopening as per Johns Hopkins Coronavirus Resource Center data.)