Grant J Riew1, Francis Lovecchio2, Dino Samartzis3,4, David N Bernstein5, Ellen Y Underwood6, Philip K Louie7, Niccole Germscheid8, Howard S An3,4, Jason Pui Yin Cheung9, Norman Chutkan10, Gary Michael Mallow3,4, Marko H Neva11, Frank M Phillips3,4, Daniel M Sciubba12, Mohammad El-Sharkawi13, Marcelo Valacco14, Michael H McCarthy15, Sravisht Iyer2, Melvin C Makhni16. 1. Harvard Medical School, Boston, MA, USA. 2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. 3. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. 4. The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA. 5. Department of Orthopaedic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. 6. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard University, Boston, MA, USA. 7. Virginia Mason Medical Center, Neuroscience Institute, Seattle, WA, USA. 8. Research Department, AO Spine International, Davos, Switzerland. 9. Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China. 10. Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA. 11. Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, Tampere, Finland. 12. Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA. 13. Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt. 14. Department of Orthopaedics, Churruca Hospital de Buenos Aires, Buenos Aires, Argentina. 15. Indiana Spine Group, Carmel, IN, USA. 16. Department of Orthopaedic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. mmakhni@bwh.harvard.edu.
Abstract
INTRODUCTION: While telemedicine usage has increased due to the COVID-19 pandemic, there remains little consensus about how spine surgeons perceive virtual care. The purpose of this study was to explore international perspectives of spine providers on the challenges and benefits of telemedicine. METHODS: Responses from 485 members of AO Spine were analyzed, covering provider perceptions of the challenges and benefits of telemedicine. All questions were optional, and blank responses were excluded from analysis. RESULTS: The leading challenges reported by surgeons were decreased ability to perform physical examinations (38.6%), possible increased medicolegal exposure (19.3%), and lack of reimbursement parity compared to traditional visits (15.5%). Fewer than 9.0% of respondents experienced technological issues. On average, respondents agreed that telemedicine increases access to care for rural/long-distance patients, provides societal cost savings, and increases patient convenience. Responses were mixed about whether telemedicine leads to greater patient satisfaction. North Americans experienced the most challenges, but also thought telemedicine carried the most benefits, whereas Africans reported the fewest challenges and benefits. Age did not affect responses. CONCLUSION: Spine surgeons are supportive of the benefits of telemedicine, and only a small minority experienced technical issues. The decreased ability to perform the physical examination was the top challenge and remains a major obstacle to virtual care for spine surgeons around the world, although interestingly, 61.4% of providers did not acknowledge this to be a major challenge. Significant groundwork in optimizing remote physical examination maneuvers and achieving legal and reimbursement clarity is necessary for widespread implementation.
INTRODUCTION: While telemedicine usage has increased due to the COVID-19 pandemic, there remains little consensus about how spine surgeons perceive virtual care. The purpose of this study was to explore international perspectives of spine providers on the challenges and benefits of telemedicine. METHODS: Responses from 485 members of AO Spine were analyzed, covering provider perceptions of the challenges and benefits of telemedicine. All questions were optional, and blank responses were excluded from analysis. RESULTS: The leading challenges reported by surgeons were decreased ability to perform physical examinations (38.6%), possible increased medicolegal exposure (19.3%), and lack of reimbursement parity compared to traditional visits (15.5%). Fewer than 9.0% of respondents experienced technological issues. On average, respondents agreed that telemedicine increases access to care for rural/long-distance patients, provides societal cost savings, and increases patient convenience. Responses were mixed about whether telemedicine leads to greater patient satisfaction. North Americans experienced the most challenges, but also thought telemedicine carried the most benefits, whereas Africans reported the fewest challenges and benefits. Age did not affect responses. CONCLUSION: Spine surgeons are supportive of the benefits of telemedicine, and only a small minority experienced technical issues. The decreased ability to perform the physical examination was the top challenge and remains a major obstacle to virtual care for spine surgeons around the world, although interestingly, 61.4% of providers did not acknowledge this to be a major challenge. Significant groundwork in optimizing remote physical examination maneuvers and achieving legal and reimbursement clarity is necessary for widespread implementation.
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