Movement Disorders and Telemedicine: Q&A With Natalie Witek, MD, MS

May 21, 2020
Natalie Witek

Telemedicine connections are more important than ever during the COVID-19 pandemic. The Rush Parkinson's Disease and Movement Disorders Program has been offering telemedicine visits for patients since 2015, and its providers know how beneficial these visits can be.

Telemedicine visits have been a great resource and convenience for movement disorders patients who live far away from Rush or have trouble getting to the office in person. Since the COVID-19 pandemic began, scheduled video visits have been an essential way for Rush movement disorders providers to continue to offer excellent care while keeping their patients safe.

Neurologist Natalie Witek, MD, MS, answers questions about the benefits and challenges of telemedicine.

Q: Why did you decide to start offering video visits for movement disorder patients?

Witek: Telemedicine has been available through the U. S. Department of Veterans Affairs (VA) for decades and is becoming increasingly used by Rush and other health systems. Video visits are a fantastic way to provide convenient care to our patients without them having to make a trip to our main campus in Chicago. This is also a great way to provide specialty care to patients who live far from Rush, in areas without access to specialty care. Overall, it is a technology that will reshape the way we provide care to our patients.

Q: How have video visits for movement disorders grown since their inception?

Many experts have proposed the use of video telemedicine to improve access to neurologic care for patients in resource-limited regions. Previously, reimbursement from Medicare was limited to only reimbursing this service for patients in rural areas with limited access to providers. Now, due to the COVID-19 pandemic, telemedicine services are broadly covered by insurance and Medicare. Outpatient telemedicine is increasingly used to complement in-person visits, which decreases time between follow-up visits.

Patients with Parkinson's disease also have high rates of satisfaction with using telemedicine based on prior studies using this technology for follow-up visits. Telemedicine visits have been used for patients with Parkinson’s disease to make deep brain stimulation adjustments and for surgical consultations. In the past, there have been limitations to telemedicine, including reimbursements, limitations for practicing across state lines and having access to proper equipment — and some of these limitations still exist to some extent.— Since the start of the COVID-19 pandemic, the movement disorders program has rapidly expanded our volume of video visits, which has allowed our team to provide safe and effective care to our patients.

From 2015 to 2019, our program conducted under 30 video visits per year. In the first four months of 2020, we have completed over 350 video visits.

Q: What makes video visits valuable for patients and providers?

Telemedicine is a convenient, safe and fast way to provide real-time care to patients. Our patients can access video visits if they are new to Rush or existing patients who need a follow-up visit. For movement disorders, a large majority of the physical exam can be conducted over video. Other benefits of video visits include saving time in travel, caregiver burden and costs of traveling to in-person visits.

Personally, I’ve found that telemedicine allows us to provide a modern-day house call to our patients — without actually traveling to their homes. Most importantly, this technology allows us to safely provide care to our patients while stay-at-home orders are in effect for the COVID-19 pandemic.

Q: What are some challenges that your program has overcome in order to widely offer video visits for movement disorders?

Some limitations for conducting video visits in our practice include some technical challenges of using video technology through our current electronic health record. Our current system works best on an iPad or smart phone, and also requires internet access. Not all patients may have access to these resources. Also, many patients with neurologic disease may not be able to independently use these devices without assistance. To help address this, we offer telephone visits for those who do not feel comfortable coming into the clinic or who are unable to connect using video visits.

Tips for accessing video visits

Check out these resources with tips for accessing video visits:

To schedule a video visit with your provider, call Rush at (888) 352-RUSH (7874) or call your provider's practice directly.

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