Review Article | Published:

Teleneurology and mobile technologies: the future of neurological care

Nature Reviews Neurology volume 14, pages 285297 (2018) | Download Citation

Abstract

Neurological disorders are the leading cause of global disability. However, for most people around the world, current neurological care is poor. In low-income countries, most individuals lack access to proper neurological care, and in high-income countries, distance and disability limit access. With the global proliferation of smartphones, teleneurology — the use of technology to provide neurological care and education remotely — has the potential to improve and increase access to care for billions of people. Telestroke has already fulfilled this promise, but teleneurology applications for chronic conditions are still in their infancy. Similarly, few studies have explored the capabilities of mobile technologies such as smartphones and wearable sensors, which can guide care by providing objective, frequent, real-world assessments of patients. In low-income settings, teleneurology can increase the capacity of local care systems through professional development, diagnostic support and consultative services. In high-income settings, teleneurology is likely to promote the expansion and migration of neurological care away from institutions, incorporate systems of asynchronous communication (such as e-mail), integrate clinicians with diverse skill sets and reach new populations. Inertia, outdated policies and social barriers — especially the digital divide — will slow this progress at considerable cost. However, a future increasingly will be possible in which neurological care can be accessed by anyone, anywhere. Here, we examine the emerging evidence regarding the benefits of teleneurology for chronic conditions, its role and risks in low-income countries and the promise of mobile technologies to measure disease status and deliver care. We conclude by discussing the future trends, barriers and timing for the adoption of teleneurology.

Key points

  • Neurological disorders are the leading cause of global disability; however, much of the world lacks access to proper neurological care.

  • Teleneurology, the use of technology to provide remote neurological care and education, has immense potential to increase access to care for people around the world.

  • Telestroke has realized this potential, and teleneurology applications for chronic conditions are beginning to emerge.

  • Mobile technologies, especially smartphones and wearable sensors, can provide objective, frequent assessments of neurological conditions, but applications of these technologies are in their infancy.

  • In low-income settings, teleneurology can increase local capabilities through education, diagnostic assistance and consultation.

  • In high-income settings, neurological care will expand and migrate from hospitals and clinics to homes and mobile devices, incorporate systems of asynchronous communications and integrate clinicians with diverse skill sets.

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References

  1. 1.

    World Health Organization & World Federation of Neurology. Atlas: Country Resources for Neurological Disorders 2004 (WHO, 2004).

  2. 2.

    Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of telemedicine. Neurol. India 63, 142–154 (2015).

  3. 3.

    & The neurology map of the Arab world. J. Neurol. Sci. 285, 10–12 (2009).

  4. 4.

    & Neurologic services in the nations of Africa. Neurology 64, 412–415 (2005).

  5. 5.

    , , , & Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology 77, 851–857 (2011).

  6. 6.

    & Move for change part I: a European survey evaluating the impact of the EPDA Charter for People with Parkinson's disease. Eur. J. Neurol. 19, 402–410 (2012).

  7. 7.

    , & Clinical problems in the hospitalized Parkinson's disease patient: systematic review. Mov. Disord. 26, 197–208 (2011).

  8. 8.

    et al. What are wait times to see a specialist? An analysis of 26,942 referrals in southwestern Ontario. Healthc. Policy 8, 80–91 (2012).

  9. 9.

    The convenience revolution for treatment of low-acuity conditions. JAMA 310, 35–36 (2013).

  10. 10.

    , , , & Disparities in time spent seeking medical care in the United States. JAMA Intern. Med. 175, 1983–1986 (2015).

  11. 11.

    , , & Recommendations for improving neurological care. NHS South East Clinical Networks (2015).

  12. 12.

    Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary (The National Academies Press, 2012).

  13. 13.

    & Telemedicine technology and clinical applications. JAMA 273, 483–488 (1995).

  14. 14.

    & Analysis of Teladoc use seems to indicate expanded access to care for patients without prior connection to a provider. Health Aff. 33, 258–264 (2014).

  15. 15.

    , & Teleneurology by e-mail. J. Telemed Telecare 9 (Suppl. 2), 42–43 (2003).

  16. 16.

    , , , & Telemedicine for monitoring MS activity and progression. Curr. Treat. Opt. Neurol. 17, 47 (2015).

  17. 17.

    , & Systematic review of home telemonitoring for chronic diseases: the evidence base. J. Am. Med. Inform Assoc. 14, 269–277 (2007).

  18. 18.

    Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Aff. 33, 200–206 (2014).

  19. 19.

    et al. Teleneurology applications: report of the Telemedicine Work Group of the American Academy of Neurology. Neurology 80, 670–676 (2013).

  20. 20.

    et al. Store-and-forward teleneurology in developing countries. J. Telemed Telecare 7 (Suppl. 1), 52–53 (2001).

  21. 21.

    “Telestroke”: the application of telemedicine for stroke. Stroke 30, 464–469 (1999).

  22. 22.

    & The history and future of telestroke. Nat. Rev. Neurol. 9, 340–350 (2013).

  23. 23.

    et al. Telestroke-the promise and the challenge. Part one: growth and current practice. J. Neurointerv. Surg. 9, 357–360 (2017).

  24. 24.

    , , & A systematic review of telestroke. Postgrad. Med. 125, 45–50 (2013).

  25. 25.

    , , , & The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke 43, 2078–2085 (2012).

  26. 26.

    et al. Telemedicine quality and outcomes in stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 48, e3–e25 (2017).

  27. 27.

    et al. Recommendations for the implementation of telehealth in cardiovascular and stroke care: a policy statement from the American Heart Association. Circulation 135, e24–e44 (2017).

  28. 28.

    et al. Stroke telemedicine. Mayo Clin. Proc. 84, 53–64 (2009).

  29. 29.

    et al. Intravenous thrombolysis guided by a telemedicine consultation system for acute ischaemic stroke patients in China: the protocol of a multicentre historically controlled study. BMJ Open 5, e006704 (2015).

  30. 30.

    , , & Systematic review of telestroke for post-stroke care and rehabilitation. Curr. Atheroscler Rep. 15, 343 (2013).

  31. 31.

    , & The progress of telestroke in China. Stroke Vasc. Neurol. 2, 168–171 (2017).

  32. 32.

    et al. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized, controlled trial. Stroke 43, 2168–2174 (2012).

  33. 33.

    et al. Mobile stroke units for prehospital thrombolysis, triage, and beyond: benefits and challenges. Lancet Neurol. 16, 227–237 (2017).

  34. 34.

    Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. (The National Academies Press, 2001).

  35. 35.

    et al. Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria. Stroke 36, 287–291 (2005).

  36. 36.

    , , & Efficacy of telemedicine for stroke: pooled analysis of the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. Telemed J. E Health 18, 230–237 (2012).

  37. 37.

    , , , & Telemedically provided stroke expertise beyond normal working hours. Cerebrovasc. Dis. 25, 332–337 (2008).

  38. 38.

    et al. Shortening time to stroke treatment using ambulance telemedicine: TeleBAT. J. Stroke Cerebrovasc. Dis. 13, 148–154 (2004).

  39. 39.

    et al. A web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments. J. Emerg. Med. 36, 12–18 (2009).

  40. 40.

    , & Telemedicine in Stroke in Swabia, P. Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project. Stroke 34, 2951–2956 (2003).

  41. 41.

    et al. Victorian Stroke Telemedicine Project: implementation of a new model of translational stroke care for Australia. Intern. Med. J. 45, 951–956 (2015).

  42. 42.

    et al. Telestroke in resource-poor developing country model. Neurol. India 64, 934–940 (2016).

  43. 43.

    et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology 87, 1565–1574 (2016).

  44. 44.

    GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 16, 877–897 (2017).

  45. 45.

    et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Global Health 1, e259–e281 (2013).

  46. 46.

    & Comparing the supply of pediatric subspecialists and child neurologists. J. Pediatr. 146, 20–25 (2005).

  47. 47.

    et al. Association of specialist involvement and quality of care for Parkinson's disease. Mov. Disord. 22, 515–522 (2007).

  48. 48.

    , , , & Translating rare-disease therapies into improved care for patients and families: what are the right outcomes, designs, and engagement approaches in health-systems research? Genet. Med. 18, 117–123 (2016).

  49. 49.

    , & Disregard of neurological impairments associated with neglected tropical diseases in Africa. eNeurologicalSci 3, 11–14 (2016).

  50. 50.

    , , , & Telehealth: a perspective approach for visceral leishmaniasis (kala-azar) control in India. Pathog. Global Health 106, 150–158 (2012).

  51. 51.

    , , , & Virtual visits for Parkinson disease: a case series. Neurol. Clin. Pract. 4, 146–152 (2014).

  52. 52.

    Advantages and limitations of teleneurology. JAMA Neurol. 72, 349–354 (2015).

  53. 53.

    , , , & Interactive video conferencing: a means of providing interim care to Parkinson's disease patients. Mov. Disord. 8, 380–382 (1993).

  54. 54.

    , & A randomized trial of telemedicine efficacy and safety for nonacute headaches. Neurology 89, 153–162 (2017).

  55. 55.

    , , , & The cost-effectiveness of a web-based multimodal therapy for unilateral cerebral palsy: the Mitii randomized controlled trial. Dev. Med. Child Neurol. 59, 756–761 (2017).

  56. 56.

    et al. National randomized controlled trial of virtual house calls for Parkinson disease. Neurology 89, 1152–1161 (2017).

  57. 57.

    , , & Outcomes and lessons learned from a randomized controlled trial to reduce health care utilization during the first year after spinal cord injury rehabilitation: telephone counseling versus usual care. Arch. Phys. Med. Rehabil. 97, 1793–1796.e1 (2016).

  58. 58.

    , , & Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis. Mult Scler 17, 1130–1140 (2011).

  59. 59.

    et al. Functional and clinical outcomes of telemedicine in patients with spinal cord injury. Arch. Phys. Med. Rehabil. 89, 2332–2341 (2008).

  60. 60.

    , , & Depression, fatigue, and health-related quality of life among people with advanced multiple sclerosis: results from an exploratory telerehabilitation study. NeuroRehabilitation 18, 125–133 (2003).

  61. 61.

    , , , & Telehealth: reaching out to newly injured spinal cord patients. Public Health Rep. 116 (Suppl. 1), 94–102 (2001).

  62. 62.

    , , & Randomised controlled trial of telemedicine for new neurological outpatient referrals. J. Neurol. Neurosurg. Psychiatry 71, 63–66 (2001).

  63. 63.

    & Systematic review of studies of patient satisfaction with telemedicine. BMJ 320, 1517–1520 (2000).

  64. 64.

    , , & User satisfaction with realtime teleneurology. J. Telemed Telecare 5, 237–241 (1999).

  65. 65.

    et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N. Engl. J. Med. 364, 2199–2207 (2011).

  66. 66.

    et al. ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues. J. Am. Med. Dir. Assoc. 15, 938–942 (2014).

  67. 67.

    et al. Impact of a videoconference educational intervention on physical restraint and antipsychotic use in nursing homes: results from the ECHO-AGE pilot study. J. Am. Med. Dir. Assoc. 17, 553–556 (2016).

  68. 68.

    et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff. 30, 1176–1184 (2011).

  69. 69.

    et al. Demonopolizing medical knowledge. Acad. Med. 89, 30–32 (2014).

  70. 70.

    [No authors listed.] Project ECHO: a revolution in medical education and care delivery. The University of New Mexico School of Medicine (2017).

  71. 71.

    & State of telehealth. N. Engl. J. Med. 375, 154–161 (2016).

  72. 72.

    & The future history of home care and physician house calls in the United States. J. Gerontol. A Biol. Sci. Med. Sci. 56, M603–M608 (2001).

  73. 73.

    et al. Epidemiology of the homebound population in the United States. JAMA Intern. Med. 175, 1180–1186 (2015).

  74. 74.

    , , , & Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale. Stroke 30, 2141–2145 (1999).

  75. 75.

    et al. A pilot study of virtual visits in Huntington disease. J. Huntingtons Dis. 3, 189–195 (2014).

  76. 76.

    et al. Remote assessment of cognitive function in juvenile neuronal ceroid lipofuscinosis (Batten disease): a pilot study of feasibility and reliability. J. Child Neurol. 31, 481–487 (2016).

  77. 77.

    et al. Increasing access to specialty care: a pilot, randomized controlled trial of telemedicine for Parkinson's disease. Mov Disord. 25, 1652–1659 (2010).

  78. 78.

    et al. Comparison of office-based versus home Web-based clinical assessments for Parkinson's disease. Mov Disord. 27, 308–311 (2012).

  79. 79.

    , , , & Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach. J. Multidiscip. Healthc. 10, 205–215 (2017).

  80. 80.

    et al. Randomized controlled clinical trial of “virtual house calls” for Parkinson disease. JAMA Neurol. 70, 565–570 (2013).

  81. 81.

    et al. The anatomy of medical research: US and international comparisons. JAMA 313, 174–189 (2015).

  82. 82.

    et al. The Medical Education Partnership Initiative (MEPI), a collaborative paradigm for institutional and human resources capacity building between high- and low- and middle-income countries: the Mozambique experience. Global Health Action 10, 1272879 (2017).

  83. 83.

    in July / August 2017 Global Health Matters Newsletter (Fogarty International Center, Washington, DC, 2017).

  84. 84.

    et al. Validation of a smartphone-based EEG among people with epilepsy: a prospective study. Sci. Rep. 7, 45567 (2017).

  85. 85.

    , , & Telemedicine for distance education in neurology: preliminary experience in India. J. Telemed Telecare 10, 363–365 (2004).

  86. 86.

    , , & Telemedicine in neurology: underutilized potential. Neurol. India 53, 27–31 (2005).

  87. 87.

    et al. Telemedicine — the way ahead for medicine in the developing world. Trop. Doct 33, 36–38 (2003).

  88. 88.

    & International issues: teleneurology in humanitarian crises: lessons from the Medecins Sans Frontieres experience. Neurology 89, e16–e19 (2017).

  89. 89.

    , , , N' & Tele-transmission of EEG recordings. Neurophysiol. Clin. 45, 121–130 (2015).

  90. 90.

    , & A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries. BMC Public Health 16, 572 (2016).

  91. 91.

    , , , & Novel methods and technologies for 21st-century clinical trials: a review. JAMA Neurol. 72, 582–588 (2015).

  92. 92.

    Alzheimer's test may undermine drug trials. Nature (2012).

  93. 93.

    , , & The first frontier: digital biomarkers for neurodegenerative disorders. Digital Biomarkers 1, 6–13 (2017).

  94. 94.

    , , & The digital phenotype. Nat. Biotechnol. 33, 462–463 (2015).

  95. 95.

    , , & MotorBrain: a mobile app for the assessment of users' motor performance in neurology. Comput. Methods Programs Biomed. 143, 35–47 (2017).

  96. 96.

    , & Subjective perception of sleep benefit in Parkinson's disease: valid or irrelevant? Parkinsonism Relat. Disord. 42, 90–94 (2017).

  97. 97.

    et al. Development of a portable tool for screening neuromotor sequelae from repetitive low-level blast exposure. Mil. Med. 182, 147–154 (2017).

  98. 98.

    et al. The mPower study, Parkinson disease mobile data collected using ResearchKit. Sci. Data 3, 160011 (2016).

  99. 99.

    et al. A validation study of a smartphone-based finger tapping application for quantitative assessment of bradykinesia in Parkinson's disease. PLoS ONE 11, e0158852 (2016).

  100. 100.

    , & Validation of a smartphone application measuring motor function in Parkinson's disease. J. Parkinsons Dis. 6, 371–382 (2016).

  101. 101.

    et al. The novel quantitative measures of gait and posture in Parkinson's disease: cross-sectional analysis [Japanese]. Rinsho Shinkeigaku 55, 259–262 (2015).

  102. 102.

    et al. Differential diagnosis between Parkinson's disease and essential tremor using the smartphone's accelerometer. PLoS ONE 12, e0183843 (2017).

  103. 103.

    et al. Consumer sleep technologies: a review of the landscape. J. Clin. Sleep Med. 11, 1455–1461 (2015).

  104. 104.

    , & Mobile medical applications in neurology. Neurol. Clin. Practice 3, 52–60 (2013).

  105. 105.

    et al. Measuring the lifespace of people with Parkinson's disease using smartphones: proof of principle. JMIR Mhealth Uhealth 2, e13 (2014).

  106. 106.

    et al. The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit. Nat. Biotechnol. 35, 354–362 (2017).

  107. 107.

    et al. Investigation of anticipatory postural adjustments during one-leg stance using inertial sensors: evidence from subjects with Parkinsonism. Front. Neurol. 8, 361 (2017).

  108. 108.

    et al. Quantitative biomechanical assessment of trunk control in Huntington's disease reveals more impairment in static than dynamic tasks. J. Neurol. Sci. 376, 29–34 (2017).

  109. 109.

    , , , & Validity of the instrumented push and release test to quantify postural responses in persons with multiple sclerosis. Arch. Phys. Med. Rehabil. 98, 1325–1331 (2017).

  110. 110.

    et al. Multiple wearable sensors in Parkinson and Huntington disease individuals: a pilot study in clinic and at home. Digital Biomarkers 1, 52–63 (2017).

  111. 111.

    et al. Clinical assessment of gait in individuals with multiple sclerosis using wearable inertial sensors: comparison with patient-based measure. Mult. Scler. Relat. Disord. 10, 187–191 (2016).

  112. 112.

    et al. Dopaminergic-induced dyskinesia assessment based on a single belt-worn accelerometer. Artif. Intell. Med. 67, 47–56 (2016).

  113. 113.

    , , , & Pull Test estimation in Parkinson's disease patients using wearable sensor technology. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2015, 3109–3112 (2015).

  114. 114.

    et al. l-DOPA and freezing of gait in parkinson's disease: objective assessment through a wearable wireless system. Front. Neurol. 8, 406 (2017).

  115. 115.

    et al. Automatic classification of tremor severity in Parkinson's disease using a wearable device. Sensors 17, 2067 (2017).

  116. 116.

    et al. Wearable sensors objectively measure gait parameters in Parkinson's disease. PLoS ONE 12, e0183989 (2017).

  117. 117.

    et al. Feasibility of large-scale deployment of multiple wearable sensors in Parkinson's disease. PLoS ONE 12, e0189161 (2017).

  118. 118.

    et al. Continuous daily assessment of multiple sclerosis disability using remote step count monitoring. J. Neurol. 264, 316–326 (2017).

  119. 119.

    The quantified self: fundamental disruption in big data science and biological discovery. Big Data 1, 85–99 (2013).

  120. 120.

    The measured life. MIT Technology Review (2011).

  121. 121.

    et al. The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) trial: the value of wireless remote monitoring with automatic clinician alerts. J. Am. Coll. Cardiol. 57, 1181–1189 (2011).

  122. 122.

    et al. A randomized trial of long-term remote monitoring of pacemaker recipients (the COMPAS trial). Eur. Heart J. 33, 1105–1111 (2012).

  123. 123.

    Twenty years of telemedicine in chronic disease management—an evidence synthesis. J. Telemed Telecare 18, 211–220 (2012).

  124. 124.

    & Critical review of the responsive neurostimulator system for epilepsy. Med. Devices 8, 405–411 (2015).

  125. 125.

    [No authors listed.] Johns Hopkins EpiWatch: app and research study. John Hopkins Medicine (2017).

  126. 126.

    et al. Wrist sensor reveals sympathetic hyperactivity and hypoventilation before probable SUDEP. Neurology 89, 633–635 (2017).

  127. 127.

    The Ontario Telemedicine Network: a case report. Telemed. J. E Health 19, 373–376 (2013).

  128. 128.

    et al. High patient satisfaction with telehealth in Parkinson disease: A randomized controlled study. Neurol. Clin. Pract. 6, 241–251 (2016).

  129. 129.

    mHealthNews. VA poised to ramp up telehealth in 2015. MobiHealthNews (2014).

  130. 130.

    , , & Teleneurology: successful delivery of chronic neurologic care to 354 patients living remotely in a rural state. Telemed. J. E Health 20, 473–477 (2014).

  131. 131.

    Brief history of telemedicine. Electronic Design (2006).

  132. 132.

    & History of telemedicine: evolution, context, and transformation. Healthc. Inform. Res. 16, 65–66 (2010).

  133. 133.

    , , & Multidisciplinary model of dementia care in an underserved retirement community, made possible by telemedicine. Front. Neurol. 7, 225 (2016).

  134. 134.

    et al. National randomized controlled trial of virtual house calls for people with Parkinson's disease: interest and barriers. Telemed. J. E Health 22, 590–598 (2016).

  135. 135.

    Digital Divides 2015. Pew Reseacrh Center Internet & Technology (2015).

  136. 136.

    et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 11, 397–404 (2012).

  137. 137.

    et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 311, 1622–1631 (2014).

  138. 138.

    et al. Benefits of stroke treatment using a mobile stroke unit compared with standard management: the BEST-MSU study run-in phase. Stroke 46, 3370–3374 (2015).

  139. 139.

    , & 'Mobile' health needs and opportunities in developing countries. Health Aff. 29, 252–258 (2010).

  140. 140.

    & A web-based telemedicine system for low-resource settings 13 years on: insights from referrers and specialists. Global Health Action 6, 21465 (2013).

  141. 141.

    [No authors listed.] Health expenditure per capita, PPP (constant 2011 international $), China. The World Bank (2014).

  142. 142.

    [No authors listed.] Health expenditure per capita, PPP (constant 2011 international $), India. The World Bank (2014).

  143. 143.

    Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries? Global Health 2, 9 (2006).

  144. 144.

    By 2020, 90% of the world's population aged over 6 will have a mobile phone: Report. TNW (2014).

  145. 145.

    & Determinants of patient waiting time in the general outpatient department of a tertiary health institution in north Western Nigeria. Ann. Med. Health Sci. Res. 3, 588–592 (2013).

  146. 146.

    & Delayed access to health care and mortality. Health Services Res. 42, 644–662 (2007).

  147. 147.

    , , & Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Aff. 36, 485–491 (2017).

  148. 148.

    & The return of the house call. Ann. Intern. Med. 162, 587–588 (2015).

  149. 149.

    Kaiser Permanente Northern California: current experiences with internet, mobile, and video technologies. Health Aff. 33, 251–257 (2014).

  150. 150.

    et al. Treating disordered speech and voice in Parkinson's disease online: a randomized controlled non-inferiority trial. Int. J. Lang. Commun. Disord. 46, 1–16 (2011).

  151. 151.

    Huntington's Disease Society of America launches first-of-its-kind free telehealth counseling for HD families. HDSA (2017).

  152. 152.

    , & Health Promotion and Interactive Technology: Theoretical Applications and Future Directions (Lawrence Erlbaum Associates, 1997).

  153. 153.

    The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care 1st edn (Basic Books, 2013).

  154. 154.

    The Patient Will See You Now: The Future of Medicine is in Your Hands. (Basic Books, 2015).

  155. 155.

    & Social uses of personal health information within PatientsLikeMe, an online patient community: what can happen when patients have access to one another's data. J. Med. Internet Res. 10, e15 (2008).

  156. 156.

    & Revolutionising management of chronic disease: the ParkinsonNet approach. BMJ 348, g1838 (2014).

  157. 157.

    ParkinsonNet: a low-cost healthcare innovation with a systems' approach from the Netherlands. Health Aff. 36, 1987–1996 (2017).

  158. 158.

    The Singularity is Near: When Humans Transcend Biology (Viking, 2005).

  159. 159.

    , & VA telemedicine: an analysis of cost and time savings. Telemed J. E Health 22, 209–215 (2016).

  160. 160.

    et al. How NYP used its innovation stack to launch a telehealth program. NEJM Catalyst (2017).

  161. 161.

    & Why Mayo Clinic's CEO wants to serve 200 million patients — and how he plans to do it [Interview]. Advisory Board (2014)

  162. 162.

    , & Disrupting Class: How Disruptive Innovation Will Change the Way the World Learns. (McGraw-Hill, 2008).

  163. 163.

    The doctor's office of 2024 — 4 predictions for the future. Software Advice (2017).

  164. 164.

    Tractica. Remote Video Consultations in Clinical and Non-Clinical Environments: Global Market Analysis and Forecasts (Tractica, 2015).

  165. 165.

    Almost one in six doctor visits will be virtual this year. ComputerWorld (2014).

  166. 166.

    & Here's what your future doctor visits could look like. Fortune (2017).

  167. 167.

    & Right tech, wrong time. Harvard Business Review (2016).

  168. 168.

    Internet access growing worldwide but remains higher in advanced economies. Pew Research Center (2016).

  169. 169.

    Miniwatts Marketing Group. Internet Users in Africa, June 2017. Internet World Stats: Usage and Population Statistics (2017).

  170. 170.

    & The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Global Health Action 5, 15638 (2012).

  171. 171.

    BRCK could bring a reliable internet connection to some of the most remote parts of Africa. TheNextWeb (2014).

  172. 172.

    Smartphone ownership rates skyrocket in many emerging economies, but the digital divide remains. Pew Research Center (2016).

  173. 173.

    Telemedicine finally makes inroads into the Asia-Pacific market, finds Frost & Sullivan. Frost & Sullivan (2015).

  174. 174.

    Telemedicine: The legal framework (or the lack of it) in Europe. GMS Health Technol. Assess. 12, Doc03 (2016).

  175. 175.

    & State Telemedicine Gaps Analysis: Coverage & Reimbursement (American Telemedicine Association, 2016).

  176. 176.

    [No authors listed.] Next generation ACO model telehealth waiver frequently asked questions. CMS (2018).

  177. 177.

    Telehealth-friendly CHRONIC care act passes first senate hurdle. mHealth Intelligence (2017).

  178. 178.

    The hidden economics of telemedicine. Ann. Intern. Med. 163, 801–802 (2015).

  179. 179.

    & Helmsley trust support for telehealth improves access to care in rural and frontier areas. Health Aff. 33, 336–341 (2014).

  180. 180.

    , , , & Improving access and mobility — the Interstate Medical Licensure Compact. N. Engl. J. Med. 372, 1581–1583 (2015).

  181. 181.

    Digital Divide: civic Engagement, Information Poverty, and the Internet Worldwide. (Cambridge Univ. Press, 2001).

  182. 182.

    & Chronic Disease and the Internet. (Pew Internet & American Life Project Washington, DC, 2010).

  183. 183.

    ICT Facts and Figures 2017 (International Telecommunication Union, Geneva, 2017).

  184. 184.

    et al. Minority enrollment in Parkinson's disease clinical trials. Parkinsonism Relat. Disord. 15, 258–262 (2009).

  185. 185.

    et al. The effects of telemedicine on racial and ethnic disparities in access to acute stroke care. J. Telemed. Telecare 22, 114–120 (2016).

  186. 186.

    et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 68, 384–386 (2007).

  187. 187.

    et al. Setting up a Neuroscience Stroke and Rehabilitation Centre in Brunei Darussalam by a transcontinental on-site and telemedical cooperation. Int. J. Stroke 12, 132–136 (2017).

  188. 188.

    , , & Systematic review of teleneurology: neurohospitalist neurology. Neurohospitalist 3, 120–124 (2013).

  189. 189.

    Neurocritical care in developing countries. Neurocrit. Care 15, 593–598 (2011).

  190. 190.

    , , & Palliative care and neurology: time for a paradigm shift. Neurology 83, 561–567 (2014).

  191. 191.

    et al. Development of a Chronic Care Model for Neurological Conditions (CCM-NC). BMC Health Serv. Res. 14, 409 (2014).

  192. 192.

    , , , & Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 287, 1022–1028 (2002).

  193. 193.

    et al. Ericsson Mobility Report (Ericsson, 2017).

  194. 194.

    , & Clinical telemedicine utilization in Ontario over the Ontario Telemedicine Network. Telemed J. E Health 22, 473–479 (2016).

  195. 195.

    National Center for Health Statistics. National Ambulatory Medical Care Survey (U. S. Department of Health and Human Services, 2013).

  196. 196.

    & Remote Video Consultations in Clinical and Non-Clinical Environments: Global Market Analysis and Forecasts (Tractitca, 2015).

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Acknowledgements

E.R.D. was supported through a Patient-Centered Outcomes Research Institute Program Award (DI-1605-35338) and from grants from the US National Institute of Neurological Disorders and Stroke (P20NS092529-02) and the Burroughs Wellcome Fund (1016426). G.L.B. was supported by the University of Rochester's Rykenboer Professorship and by the US National Institute of Neurological Disorders and Stroke (R01NS094037). L.H.S. was supported by the Massachusetts General Hospital Center for TeleHealth, the Patient-Centered Outcomes Research Institute (CDRN-1306-04608) and the US National Institute of Neurological Disorders and Stroke (UO1 NS077179 and U10 NS086729).

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Affiliations

  1. Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.

    • E. Ray Dorsey
    • , Alistair M. Glidden
    • , Melissa R. Holloway
    •  & Gretchen L. Birbeck
  2. Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.

    • E. Ray Dorsey
    •  & Gretchen L. Birbeck
  3. Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.

    • Gretchen L. Birbeck
  4. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.

    • Lee H. Schwamm

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Contributions

All authors researched data for the Review, made substantial contributions to the discussion of the content of the article and reviewed and edited the manuscript before submission. E.R.D., G.L.B. and L.H.S. wrote the article.

Competing interests

E.R.D. is a member of the medical advisory board and owns stock options in Grand Rounds, an online second-opinion service, is a consultant to MC10, a wearable sensor company, and has research grants related to telehealth from AbbVie, the Burroughs Wellcome Fund, the Greater Rochester Health Foundation, the US NIH, the Patient-Centered Outcomes Research Institute and the Safra Foundation. L.H.S. is a consultant to and owns stock options in LifeImage, a teleradiology company, and is the teleneurology consultant to several network research grants from the US NIH and the Patient-Centered Outcomes Research Institute. G.L.B., A.M.G., and M.R.H. have no competing interests to declare.

Corresponding author

Correspondence to E. Ray Dorsey.

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DOI

https://doi.org/10.1038/nrneurol.2018.31