Taking Telemedicine to the Next Level: Cleveland Clinic Epilepsy Center

Imad Najm, MD

As the director of the Epilepsy Center and vice chair of the Neurological Institute for Strategy and Development at Cleveland Clinic, Imad Najm, MD, is at the forefront of the latest technologies being used to improve patient care. While not a new concept, telemedicine technology is being taken to the next level by Najm and his colleagues, allowing physicians to interact with patients and other clinicians around the world.

Telemedicine not only makes in-person visits unnecessary, but it also eliminates transportation costs and reduces the physical footprints of care centers. Although it sometimes requires some convincing, physicians and patients at Cleveland Clinic are already warming up to the idea of incorporating technology into their routine care. In an interview with NeurologyLive, Najm detailed the ceaseless opportunities that telemedicine can offer to both physicians and patients alike.

NeurologyLive: How are you incorporating telemedicine technology into your current clinical practice model?

Imad Najm, MD: With medicine, were usually behind technology for many years. And that's why I'm personally extremely excited that there is a technology that has been available for years that we’re now using to see our patients and for our daily care of our patients. We are, at Cleveland Clinic, extremely excited about telemedicine and we've been one of the national pioneers in the use of this technology to care for our patients. In particular, the Neurological Institute and the Epilepsy Center have been one of the leaders in using it.

We are using telemedicine to care for patients at roughly 3 levels: the first one is using teleneurology or telemedicine to directly interact and care for patients with epilepsy and other neurological disorders. At a place like Cleveland Clinic, we have a significant number of our patients come in from outside our regional area. This technology is a major game changer for us, because it enables us to see our patients wherever they are and enable our patients to see us from wherever they are--this is what we call virtual visits. We are available for them whenever they need us, rather than having to wait for 2 to 3 days to make a hotel reservation, to make an airline reservation, to be able to take the vacation to come here and do this. It’s enabling people even 10 miles from where we are to take 10 minutes from their work schedule to come to a private room, connect with us using their cell phone, get the physician to see them, to alleviate some of their angst, and to help them. That's one way to do it.

The other way we've been doing it here since 2010, and in epilepsy in particular, is we’re using the concept of telemedicine to reach out to hospitals, to colleagues of ours who are in areas where they don't have access to highly specialized groups or individuals. In epilepsy, we are using technology to monitor patients who are, for example in Florida, part of Cleveland Clinic Florida, who are in our Abu Dhabi, part of Cleveland Clinic Abu Dhabi. We have 10 other hospitals here that we are using technology to monitor them live, to give immediate input to the treating team where they are, and to make sure that we monitor the treatment options that they are implementing in these particular patients. This has been to us, a major plus to continue to reach out to our patients wherever they are, and to deliver some of our treatment and diagnostic techniques or procedures with the patients still close to home. The third way that we've been using telemedicine is physician-to-physician discussion, where our colleagues, part of our Cleveland Clinic system or outside, can connect to us live via TV. We have all of the specialists here, and they can then present the case for us, where we give a physician-to-physician opinion, what we think of the diagnosis, what we think about the treatment options and the prognosis. With this here, we're just scratching the surface.

How has telemedicine been received among doctors and patients? Is there a willingness to participate in this new technology?

I think the patients, they love it, the majority of them love it. From time to time, we have a patient who says, “No, doc. I'm going to drive 4 or 5 hours because I would like to see you, I would you like to shake your hand,” which is keeping the human part of medicine alive, which is good. But the majority of patients, when the physician talks with them about this particular technology and the availability of care, they are extremely excited about it, with 1 caveat. The question they often ask is, “Doc, are you going to see me or is somebody else going to do the visit?” If the physician is there, some of the pressure on the patient is gone. They are actually so excited about it because now, all of a sudden, they don't need to ask a friend or get their husband or wife to drive them for 5 hours for a 30 minute visit and go back home. From this aspect, I think the patients are extremely open to this possibility, and they receive it very, very well.

Now, physicians, it's not as easy. I'm a physician and I critique myself first. You know, we have always our ways that we learned that this is how we're going to do our job. Usually this will be molded in us during our residency and fellowship, and then once we start practicing, we develop certain ways of doing things and it becomes very hard for us, as physicians, to change these habits. As an administrator of a department, I always think about physicians with the rule of thirds. One third of the physicians embrace anything new; one third will be very resistant; and one third will say, “Let me see how you do it and I will do it after you.” We went through all the phases here and I'm happy to tell you that within our epilepsy center, every physician adopted this technology by seeing patients through telemedicine. Every physician now feels extremely comfortable dealing with other patients outside the physical confines of the Cleveland Clinic main campus here and every physician feels comfortable discussing a case live with another physician somewhere else. But it takes a lot of convincing; it takes a person who is going to take a leadership role and a person who is going to show results, and slowly, people will start to accept it. I personally think in the next 5 years, that almost every department at this hospital and probably many hospitals, will be using this technology.

How do you foresee the implementation of telemedicine technology changing the way you practice?

Imagine the savings from work hours lost, to transportation, to time lost, use of resources, physical resources. We are now in the process of designing our new Neurological Institute building, and one thing that we are trying to factor in, is the impact of digital technology on us. Do we really need all the space that we have now? We've now doubled our patients, but we may need less space. This paradigm shift would not have been possible if we did not have access to digital technology to talk to the patients, diagnosis patients, and manage the patient from a distance. It's going to be a game changer, where the physical confines of things are not going to be a limitation anymore. We're going to be able to reach out to the world, and the world will be able to reach out to us.

Transcript edited for clarity.