Abstracts

Rationale: Telemedicine provides patients with expanded access to medical care. Given the shortage of pediatric epileptologists and their concentration in major cities, telemedicine can be an important resource for children and youth with epilepsy (CYE), especially patients who live in medically underserved areas. Early evaluation by a Comprehensive Epilepsy Center (CEC) has been recommended as part of the AAN Epilepsy quality metrics.  The Pediatric Epilepsy Telemedicine Clinic at Michigan Medicine was originally developed for established patients with epilepsy. Through a partnership between a community pediatric neurology practice in Marquette, MI and the Pediatric Epilepsy Telemedicine Clinic, a unique role was identified for pediatric epilepsy telemedicine consults. Methods: The need for improved access to a CEC was identified in the medically underserved Michigan Upper Peninsula by the community neurologist (CN) and epileptologist at Michigan Medicine.  A workflow was developed for patient identification, telehealth technology, provider credentialing and reimbursement. Synchronous visits connect the epileptologist, CN, patient and caregivers via secure video technology in full compliance with industry standards and current HIPAA telehealth guidelines. The comprehensive consultation includes a history, focused examination (performed by the CN), medication, and record review, and medical decision making.  Where indicated patient videos are shared through secure email. Institutional documentation and billing practices are followed. Results: Between 7/2017-4/2018, 6 unique patients, ages 16 months – 17 years, were referred and evaluated  for subspecialty epilepsy consults via telemedicine.  The reasons for evaluation included: paroxysmal events, intractable epilepsy and dietary treatment.  In each case, appropriate evaluation and treatment was initiated.  For those who required further evaluation, the telemedicine consultation allowed this care to be planned prior to travel to the CEC. 4/5 patients required tests at the CEC; of these 2 required inpatient studies (EEG monitoring and neuroimaging with sedation) which couldn’t be accomplished locally. For all patients, evaluation/appointments at the CEC were arranged in one contiguous block of time, thus decreasing travel time and expenses for the family. Where indicated, follow-up was coordinated via telemedicine. Conclusions: This partnership demonstrates the feasibility of using telemedicine for access to a CEC, and highlights the unique benefits of telemedicine visits to provide subspecialty care and second opinions for CYE. The teleconsultations also eliminated patient travel of over 4.5 hours and 440 miles each way. These visits expand access to expert opinion; minimize the financial burden to families; and can increase both provider and patient family satisfaction. These three-way telemedicine consults between patient families, the CN, and a pediatric epileptologist are a cost-effective and time-effective way to coordinate patient care. Telemedicine can be a model for improving access to quality care in accordance with AAN quality metrics.  Funding: This work was funded by a HRSA grant H98MC30374.