Momentum telemedicine service descriptions
Remote intraoperative neuromonitoring (NL)
Objectives, expected outcomes, main beneficiaries
The aim of the Remote intraoperative neuromonitoring service is to make intraoperative neuromonitoring available to as many (neuro) surgeons and patients as possible within the Netherlands, but also across the country’s borders (in Germany and Switzerland), to prevent neurological complications (such as hemiparesis, aphasia, and paralysis) when applying several surgical strategies. It is expected to be cost-saving, clinically effective and efficient, saving time for the specialist in charge (a clinical neurophysiologist). The beneficiaries are described as “all“.
Targeted population, number of patients
The targeted population is patients undergoing specific treatment, i.e., patients undergoing surgery in which the central (or peripheral) nervous system is at risk of severe complications. These are, for example, patients undergoing brain surgery, vascular surgery and spine medullary surgery.
The number of patients who use the patients on a monthly basis is between 20-50. The estimated size of the targeted population is up to 10,000.
Type of telemedicine service
The service category is monitoring. The relationship between key actors in the service is secondary care/secondary care.
Set-up that was being replaced
The conventional treatment also consists of intraoperative neuromonitoring, in the same way as it is used now. The only difference is that the clinical neurophysiologist who is needed for the interpretation of the procedure does not have to be in the room, and not even in the same hospital or in the same country.
As the technique of neuromonitoring is very time-consuming, and many hospitals – and even countries – lack the specialised clinical neurophysiologists necessary, the technique is not used as often as needed.
By doing teleneuromonitoring intraoperatively from a remote location, the technique is used by a lot more surgeons, patients and hospitals. If the hospital has its own clinical neurophysiologist specialist, it can monitor the surgery – mostly also remotely – from within the hospital. If the hospital does not have its own specialist, by using live intraoperative teleneuromonitoring, the surgeon can benefit from using the knowledge of a specialist in another hospital or even in another country so as to ensure postoperatively the quality of life of his or her patient.
Outcomes and results expected after introduction
The service was expected to be cost-saving, clinically effective, time-saving and to also improve the quality of the surgery and effect a decrease in postoperative neurological morbidity, thus leading to better quality of life for the patients.
The service provides monitoring of central nervous system (CNS) function during surgery. In this way, it can prevent major complications during surgery. Since the monitoring is very time-consuming, and a lot of hospitals lack an experienced clinical neurophysiologist/neurologist who can perform this procedure, the remote delivery of the service makes monitoring possible for more hospitals, surgeons and, most important, patients.
The service is provided in the hospital from the operating room (OR) to the clinical neurophysiology (CN) department by means of virtual network computing (VNC) software or by means of Cisco Webex Meeting software – if mobility of the clinical neurophysiologist is necessary.
This tele-neuromonitoring is also provided to other hospitals across borders (these include Maastricht-Aachen, Germany; Maastricht-Bern, Switzerland; Maastricht-Hamburg, Germany and Maastricht-Regensburg, Germany), through Cisco Webex software that makes use of Internet connections. In the receiving hospital a local technologist, who has been trained in the hospital, starts and performs the monitoring procedure. Signals are interpreted by one of our clinical neurophysiologists in our own hospital remotely. Communication with the surgeon and the technologist in the receiving hospital is performed by various means: the use of the chat option in Cisco Webex, or by means of Skype (video and audio), or direct phone connection.