Connections: Looming crisis for neurology access generates creative strategies | Fall 2019

Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.

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From the OHSU Brain Institute

HCM Connections Magazine Jacqueline Bernard headshot

Jacqueline T. Bernard, M.D., FAAN

Dr. Bernard is a neurologist specializing in multiple sclerosis and demyelinating disorders. She has a research interest in using optical coherence tomography in neurological disorders.

There is such a shortage of neurologists that estimates suggest we will reach a crisis in care as early as 2025 without more neurology services. At OHSU, we are getting creative and experimenting with several outreach methods.

Virtual visits for existing neurology patients

Currently, virtual visits are available for existing OHSU neurology patients who live in Oregon, with a goal to expand service to new patients in early 2020.

Over the last six months, the use of Skype-like video visits for neurologic care has produced positive patient feedback. Patients who are capable of being fully engaged and problem-focused can choose virtual visits for alternating return appointments or for issues between visits. Patients who choose virtual visits say they appreciate the convenience of remaining in their homes. Virtual visits are HIPAA compliant, and many insurance providers are now covering telemedicine.

Streamlining the referral process and reducing wait times

OHSU Health System is collaborating with community neurology practices to streamline the referral process and increase access to general neurology. When physicians send a general neurology referral to the OHSU Physician Advice and Referral Service, the neurology team evaluates the referral and determines the best care options for the patient. The scheduler then contacts the patient to discuss appointment options.

Convenient referral locations include:

  • OHSU Adult Neurology, Portland
  • OHSU Adult Neurology, Beaverton
  • OHSU Tuality Healthcare Neurology
  • East Portland Neurology

Specialty expertise on call: eConsults

At OHSU, we’re streamlining our process to help primary care providers more efficiently get to the neurology specialist they need. Our plan is to offer eConsults to providers outside of OHSU in 2020, with the goal of keeping more patients in their home communities. When booking a neurology eConsult, providers will choose from five subspecialty topics. An OHSU neurologist will respond within two days to provide diagnostic and treatment recommendations. Providers will receive work RVU (relative value unit) credit for eConsults.

Neurology robots coming?

Over the last decade, OHSU Telestroke Network has successfully proven the advantages and viability of remotely evaluating patients for specialty care.

The telestroke neurologist interacts via video screen of a robot in the facility in need and can remotely drive the robot to the patient’s bedside. Stroke has a very short time for successful intervention.

The network allows a specialist to be bedside in 10 minutes 24/7, rather than being called in from elsewhere, if one is even available. With the shortage of neurologists, the field is considering how the same technology might work for other neurologic issues.

Free, interactive, real-time advice for neurology topics

Last year, OHSU’s Allison Lindauer, Ph.D., N.P., led two, well-received eight-week sessions on dementia through the Oregon ECHO (Extension for Community Healthcare Outcomes) Network. Sixty-seven primary care providers, social workers, psychologists and nurses participated. The real-time sessions allowed participants to ask questions and get answers immediately. Providers can present cases and get recommendations and can also include other members of their care team that would benefit.

The Oregon ECHO Network is free for participating providers. Providers receive continuing medical education credit for each session. Learn more about Oregon ECHO Network’s Project ECHO

Our goal is to provide an ECHO series on Parkinson’s disease and potentially one on multiple sclerosis. In these sessions, each case presented will be followed by discussion about diagnosis, testing, and immediate and long-term treatment plans.

When to refer or consult

As we roll out these virtual visits and distance learning opportunities beyond OHSU, we will expand options to improve access to neurology expertise.

Contact us

The OHSU Brain Institute is your partner in diagnosing and treating all neurologic disorders.

Please call the OHSU Physician Advice and Referral Service at 5034944567.

To refer a patient, please fax to 5033466854.