Past, present and future

Anno 2020, it is fair to say that remote medicine in a clinical discipline like neurology would never have gained grounds without COVID-19, and was mainly seen as an attractive tool to provide specialist care in rural areas and war zones. In the field of stroke medicine, some ambitious initiatives had been launched like the Stroke Emergency Mobile (STEMO) (a.k.a. Berlin stroke ambulance) which was designed to allow pre-hospital trombolysis. Apart from the fact that the STEMO is equipped with a computed tomography (CT) scanner, it is also linked via telemedicine to senior stroke neurologists in the Charité Hospital. In other neurology domains remote tools have always remained largely unexplored territory, and for the majority of the neurology workforce remote medicine was essentially limited to the occasional phone call to communicate some test results.

However, the COVID-19 pandemic has rendered the doctor’s consulting room and work environment into a ‘no-go’ zone. This required a logistical and digital reorganization of many neurology departments around the world which was initially not carried forward wholeheartedly by its protagonists. Although the bumpy take-off, the technological upheaval has been able to shake off prejudices and positioned itself as an asset for treatment monitoring. In the United Kingdom, direct patient contact has become the exception and clinics conducted through a telemedicine portal are the new standard. This proved to be especially useful for patients that were already under follow-up but also new patients were evaluated remotely. Also other initiaves have sprouted such as home phlebotomy and home infusion services, making many in-hospital facilities partially redundant.

With the perspective of a second wave of COVID-19 cases, the virtual neurology field is likely to move beyond the niche of follow-up clinics. While working on our screening VirtuEx, we became convinced that disease monitoring is only the tip of the virtual neurology iceberg. With an open mind and concerted action of the neurology field, the virtual examination might become a new chapter in DeJong's next edition of 'The neurological Examination'.