Jessica Fesler, MD

“We’re doing [patients] a disservice if we don’t leverage technology to take better care of them. There are a lot of downsides to technology, but this is one upside that we can really leverage to help people.”

Jessica Fesler, MD, staff epileptologist, Cleveland Clinic Epilepsy Center, and colleagues presented a large, single-center dataset showing the success and feasibility of telemedicine in epilepsy at the 

 annual meeting of the American Epilepsy Society (AES)

, December 6-10, 2019, in Baltimore, Maryland.

Their data suggest that the practice not only offers a number of advantages to patients and providers, including cost savings, convenience, time savings, etc., but that it is a feasible one for widespread use in epilepsy.

 A number of other studies have suggested similar results across the breadth of neurology.

However, there are barriers that remain in bringing this to more physicians and hospital systems—most notably, reimbursement.

To find out more about what challenges this innovation in medicine is facing and how the physician community is overcoming it, at least in epilepsy care, 

 sat with Fesler to discuss her experience in using the program at Cleveland Clinic over the last several years.

1. Fesler JR, Stanton S, Merner K. Bridging the Gap in Epilepsy Care: A Single-Center Experience of More Than 1000 Tele-Epilepsy Visits. Presented at: AES 2019; December 6—10; Baltimore, Maryland. Abstract 2.36.

2. Hatcher-Martin JM, Adams JL, Anderson ER, et al. Telemedicine in neurology: Telemedicine work group of the American Academy of Neurology update. 

2020;94:1-9. doi:10.12.12/WNL. 0000000000008708.

3. Guzik AK, Switzer JA. Teleneurology is neurology. 

. 2020;94:1-2. doi:10.1212/WNL.0000000000008693.

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Despite showing great promise to provide additional and supplementary care to patients with a number of conditions, including epilepsy, some barriers remain to bringing telemedicine to more providers and patients.

Jessica Fesler, MD: Barriers to Adopting Telemedicine

“I am excited, I think it’s the way of the future. It just works better, and as people become more comfortable with it and the technology, [it will be used more often]. Obviously, the great thing is the convenience…it reduces a lot of burden.”

, December 6-10, 2019, in Baltimore, Maryland, Jessica Fesler, MD, staff epileptologist, Cleveland Clinic Epilepsy Center, and colleagues presented a large, single-center dataset showing the success and feasibility of telemedicine in epilepsy.

Over the 35-month study period, 3698 visits were conducted with patients from 43 different states. On a 5-point scale, with 5 representing the best possible, patients rated their overall experience with the virtual visit a mean of 4.77 and rated their provider a 4.91. The visits were mostly completed with epilepsy physicians (74%; pediatric: 25%; adult: 49%), with the remaining conducted by advanced practice providers (22%), neuropsychologists (1%), and neurosurgeons (3%).

Based on their distance from the Cleveland Clinic Epilepsy Center, 26.7% (n = 571) of patients were local, defined as within 50 miles, while 30.5% (n = 652) were deemed near regional (within 51 to 150 miles), 20.1% (n = 431) considered far regional (within 151 to 270 miles), and 22.7% (n = 486) were considered remote, defined as further than 270 miles. Using those distances, roughly 928,696 miles of travel were saved for patients.

To find out more about what these data mean, and what the benefits are, for patients, 

 spoke with Fesler about her experience utilizing the technology.

Fesler JR, Stanton S, Merner K. Bridging the Gap in Epilepsy Care: A Single-Center Experience of More Than 1000 Tele-Epilepsy Visits. Presented at: AES 2019; December 6—10; Baltimore, Maryland. Abstract 2.36.

The staff epileptologist at Cleveland Clinic’s Epilepsy Center spoke to the benefits of telemedicine for patients with epilepsy, and how the practice can alleviate a number of burdens.

Jessica Fesler, MD: Alleviating Epilepsy Burden With Telemedicine

“One thing I wasn’t expecting was how you could see the patient in their environment. You learn more about them—not even so much from their medical comorbidities, but from the context of their disease.”

Telemedicine has grown in recent years into a more widely used method in the treatment of patients with a number of conditions, but at Cleveland Clinic, its expanse in epilepsy has been almost unmatched. For staff epileptologists such as Jessica Fesler, MD, it has become a regular practice in the management of patients.

The positives for patients are quite obvious from both convenience and cost-effective standpoints. With less time needed for the visit due to less travel, patients can avoid needing to take time off work, save on travel costs, and keep their physicians updated in light of inclement weather and other factors out of their control. However, clinicians can benefit from these alternative visits as well.

, December 6-10, 2019, in Baltimore, Maryland, Fesler shared her insight from her involvement with telemedicine in a conversation with 

, offering a unique perspective on some of the unexpected gains telemedicine provides clinicians.

The staff epileptologist at Cleveland Clinic’s Epilepsy Center spoke to her experience using telemedicine to manage patients with epilepsy and some of the unexpected perspectives it offers.

Author | Jessica Fesler, MD

Articles

Jessica Fesler, MD: Barriers to Adopting Telemedicine

Jessica Fesler, MD: Alleviating Epilepsy Burden With Telemedicine

Jessica Fesler, MD: Experiences With Telemedicine In Epilepsy