Background
In 1996, the Institute of Medicine (IOM) published the report “Telemedicine: A Guide to Assessing
Telecommunications for Health Care,” where telemedicine was defined as “the use of electronic
information and communications technologies to provide and support health care when distance
separates participants.” There are currently three broad categories of telemedicine technologies:
store-and-forward, remote monitoring, and (real-time) interactive services, demonstrating that since
the release of the IOM report, the definitions of telemedicine and telehealth have continued to evolve
and further change is certain.
Neurological surgery is a high acuity specialty with a limited number of practitioners; as a result,
urgent or emergent transfer of patients to tertiary hospitals with continuous neurosurgical coverage is
frequently required. Transfers may be effected for consultation due to the natural risk aversion of
non-specialist physicians who may be faced with a neurosurgical condition and feel ill-equipped to
assess the patient or offer treatment. Neurosurgical providers are not evenly geographically
distributed, which can place a significant travel burden on patients, especially those with non-urgent
issues. The disparity between the availability of neurosurgical services and the time-sensitive nature
of neurosurgical conditions has led to an interest in the use of electronic technologies to overcome
these challenges
AANS/CNS Position Statement
The timely, effectual and high-quality delivery of neurosurgical care remains the paramount mission of
neurosurgeons and their neuroscience colleagues. Through the adoption of advances in telemedicine
and telehealth technology, access to high-quality neurosurgical services can be expanded to patients
across our nation’s fifty states, territories and the District of Columbia, regardless of location. In
addition, a critical part of this expansion is fair and equitable reimbursement for telemedicine and
telehealth services across all payors, both public and private. The deployment of neurosurgery
services via telemedicine and telehealth allows more patients to receive timely intervention and
facilitate better care coordination. The AANS and CNS support appropriate use of telemedicine and
telehealth technologies to maintain our high-quality standards of care in neurosurgery, as well as the
use of streamlined state medical license processes, development of comprehensive malpractice
insurance programs, and other necessary tools that would support the efficient adoption of
telemedicine and telehealth technologies in neurosurgery.
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