Objective:

To implement and evaluate a subspecialty e-consult program within a national teleneurology program.

Background:

The VA National TeleNeurology Program (NTNP) has targeted rural, underserved Veterans in 19 locations since 2020, providing outpatient neurological care through video telehealth. The need for subspecialty consultation in complex neurological cases is widely recognized. Therefore, NTNP employed neurologists in 11 subspecialties to answer e-consults submitted by general neurologists, a system known as Neurology Expert Telemedicine (NExT).

Design/Methods:

We retrospectively reviewed total consultations, consultations per subspecialty and completion times from 4/2023-4/2025. We prospectively evaluated the first 115 referrals. E-mail surveys were sent to referring neurologists and NExT subspecialty consultants within one week of consult completion to assess views on reason for consultation, appropriateness, effectiveness, value, confidence, and satisfaction.

Results:

Over two years, 759 subspecialty e-consults were completed; the most utilized were Stroke (N=153), Movement Disorders (N=128), Neuromuscular (N=111), and Neuroimmunology (N=105). Completion times averaged 5 business days. Prospective analysis found that Management (38%) and Evaluation (22%) were the most common reasons for consultation. The majority of referring physicians felt responses were appropriate, effective and of value and therefore made changes to patient care (80%). Referring neurologists rated 92% of consults as 9 or 10 on a 10-point scale for satisfaction. 77% of NExT consultants felt they were able to resolve the e-consult completely, rating 9 or 10 on a 10-point scale. Most consultants (82%) did not identify need for additional referral to a subspecialty clinic.

Conclusions:

Providing subspecialty neurological support by e-consult in a teleneurology program is feasible and acceptable to referring neurologists and subspecialty consultants. Most patients were successfully managed by the NTNP neurologist with e-consult support, thus avoiding referral to a subspecialty clinic.  E-consults may be a novel and effective way to extend expertise typically concentrated in urban areas to rural patients in need of subspecialty neurology care.