TeleNeurology: A comprehensive suite of virtual neurology care

[6 MIN READ]

In May, Providence will celebrate TeleStroke’s 10th anniversary.
Over 10 years, TeleStroke at Providence has evolved into an extensive, decentralized network that utilizes Emergent TeleNeurology, TeleNeuroHospitalist and TeleEEG services to provide a broad continuum of care.
Learn how TeleNeurology at Providence provides life-changing patient outcomes and 24/7 care to people anytime, anywhere.

On May 20, 2015, Providence introduced TeleStroke services to provide 24/7, rapid access to our board-certified neurologists. The TeleStroke team delivers virtual, high-quality support that often saves lives when an in-person neurologist isn’t available.

Nearly 10 years later, TeleStroke is now part of a comprehensive suite of virtual neurology care at Providence known as TeleNeurology.

The evolution of stroke care

Health systems across the U.S. have been suffering from a shortage of neurologists for many years. A study published in Neurology in January 2025 noted that the average wait time frame for people with Medicare insurance to see a neurologist was more than three months after receiving a referral from a physician due to staffing issues. A study published in Neurology in January 2024 highlighted that rural areas had less access to neurologists than metropolitan areas.

Knowing this shortage was coming, Providence devised a plan: Decentralize the pool of neurologists and get the best stroke specialists on video in real time as needed for telecare.

“The whole system of care has changed so much,” says Archit C. Bhatt, M.D., executive medical director, specialties at Providence.

In the past, thrombolytics, commonly called clot-busters—drugs that break up blood clots—had to be administered within three hours to work. Now, that window of time when care can be given has increased to four and a half hours. Then mechanical thrombectomy was invented, a surgical solution to removing blood clots that, in some cases, can be performed up to 24 hours after the onset of an ischemic stroke. An ischemic stroke is when a blood clot blocks blood supply to the brain.

With more stroke treatment options available and more patients eligible for care, hospital systems have experienced an increased volume of acute stroke care everywhere.

“You can see the expansion of the acute treatment window, from giving clot-busting medication within three hours to now treating patients with a mechanical thrombectomy within 24 hours,” says Amit C. Kansara, M.D., medical director of TeleNeurology at Providence.

Another complicating layer is that stroke patient care needs to happen fast.

We want to take out the clot within 90 minutes,” Dr. Kansara says. “Every minute, the brain is losing 2 million brain cells, so that’s why earlier treatment is very important.”

A longer window of time, increased treatment options and the need for fast treatment have created a culture of hypervigilance when dealing with suspected strokes.

"Missing an ideal treatment candidate is not an option," says Dr. Kansara. "The consequences can be devastating."

For stroke patients, every moment counts, as is often referred to in the phrase "time is brain." With each passing minute of delayed treatment, more than two million neurons perish, underscoring the urgency of rapid intervention to prevent irreversible damage.

TeleStroke neurologists have specialized training, can quickly assess patients virtually and provide appropriate telehealth care. Today, TeleStroke at Providence serves 18,000 unique acute stroke patients each year at more than 82 sites nationwide.

“Providence is providing superb resources at a multi-state level,” Dr. Kansara says. “We are reaching out to millions of people through this care.”

Comprehensive emergent and inpatient neurology care

Ten years since its debut, TeleStroke at Providence is now part of an extensive, decentralized network that utilizes in-person stroke neurologists when available, along with Emergent TeleNeurology, TeleNeuroHospitalist and TeleEEG services. Here’s an explanation of each:

Emergent TeleNeurology provides patients who are experiencing stroke symptoms or urgently need critical care with a neurology assessment and treatment recommendations in both emergency and inpatient settings within minutes.
TeleNeuroHospitalist services provide admitted neurology patients with expert follow-up care, preventing unnecessary transfers.
TeleEEG services give patients suffering from seizures 24/7 access to epileptologists who can expertly read an electroencephalogram (EEG), which shows changes in brain activity.

Together, these services greatly expand the types of care available, especially in smaller emergency departments in more rural areas that don’t have a neurologist on site or are close to a comprehensive stroke center. TeleNeurology care extends beyond stroke care to that of seizures, brain tumors, paralysis and more.

Take TeleEEG, for example, which gives patients access to a virtual epileptologist, a neurologist who is an expert in epilepsy and at interpreting EEGs.

“EEG is essentially a brain wave test,” says Kitti Kaiboriboon, M.D., medical director of TeleEEG at Providence. “It is a test to see whether or not someone has seizures. For people who have epilepsy, their brain will show these seizure activities.”

A bedside caregiver administers the tests, then a virtual epileptologist interprets the tests and gives the results to the virtual neurologist who is providing ongoing neurology care. Some patients require long-term EEGs, which monitor brain activity over the course of several days.

“Most small and medium-size hospitals don’t have epileptologists in the area,” Dr. Kaiboriboon explains. “That’s why we’re now providing TeleEEG services. Many hospitals have the capability of taking care of these patients, but they don’t have the capability to do long-term EEGs.”

Adding to the continuum of care is our TeleNeuroHospitalist rounding service, which we instituted about a year and a half ago, first in Alaska, expanding to three hospitals in Oregon this year. Rounding is when doctors visit patients admitted to the hospital to check in on their progress.

“We are providing TeleNeuroHospitalist rounding services after we are done with the acute TeleNeurology part. TeleStroke or Emergent TeleNeurology is when we see patients virtually right away, provide acute advice in the ER and, sometimes, the patient gets admitted,” Dr. Kansara says. “Then we see these patients the next day for continuity of care. We work with hospitalists and nurses who help us examine the patient while we round virtually. After they get discharged, they also have a TeleNeurology clinic follow-up. We can see the patients in their homes. We tie up everything together. It’s not just a small piece of the puzzle we are helping with. We are looking at the whole thing.”

Currently, Providence’s TeleNeurology services provide expert neurological support to 82 hospitals across 8 states, offering immediate access to specialized care for a wide range of neurological conditions, including emergencies.

“We are the largest Enterprise TeleStroke/Neurology network in the country from a nonprofit standpoint,” Dr. Bhatt says. Now at Providence, TeleStroke care is a seamless blend of emergency, inpatient and follow-up neurology care.

The importance of virtual rounding in neurology and a look at what’s to come

Dr. Kansara says the TeleNeurology team at Providence plans to expand its TeleNeuroHospitalist program based on need and logistics. As neurologists are retiring and the U.S. continues to contend with a neurologist shortage, TeleNeuroHospitalist care gives a new generation of neurologists more options. Working with a large network of virtual neurologists, TeleNeuroHospitalists have schedules that are similar to clinic work with set days and hours. Also, neurologists are no longer being asked to work as solo practitioners, often resulting in little to no work-life balance because of acute stroke emergencies.

“Our goal is to provide more and more support services to rural areas and rural patient populations,” Dr. Kansara says.

Expanding TeleNeuroHospitalist care delivery is also essential to rounding in smaller, more rural hospitals.

“It’s important that these patients be evaluated by neurology because that is directly tied to hospital capacity,” Dr. Bhatt explains. “With neurology, the length of stay for stroke patients is going to be shorter.”

Dr. Bhatt cites Providence Medford Medical Center—a 168-bed community hospital in Oregon without in-house neurologists—as a prime example of the critical role TeleNeurology plays in patient care.

"Yes, some patients are complex and require hospitalization," Dr. Bhatt explains. "But hospitalists and ICU physicians often need the assurance to determine, ‘Is this patient stable enough for discharge and safe transition to the community?’ Sometimes, despite all the imaging and diagnostics, only a neurologist can make that call. From a hospital stakeholder’s perspective, this is invaluable."

Dr. Bhatt emphasizes the importance of access and the role of the tier-three hospitalist program: "Why does this matter? Because we are rounding daily, ensuring patients have a clear, safe path forward once stabilized. Length of stay and hospital capacity constraints are widespread challenges, and our goal is to optimize both—supporting hospitals in delivering timely, high-quality care while maintaining efficiency."

Virtual rounding extends a degree of confidence to stroke patients and families, too. During rounding, TeleNeuroHospitalists can show patients MRIs and point out exactly where acute ischemic strokes occurred. They also can discuss prognoses with a high level of certainty. Virtual rounding also eliminates long wait times for in-person neurology appointments following discharge.

“Instead of the patient feeling anxious for the next two or three months waiting to see a specialist, you are providing that service right there on day one,” Dr. Kansara says. “It is a tremendous value.”

Stroke care at Providence has changed for the better and will continue to change, opening worlds of access to future patients when they need it most.

“We provide a whole system of care or continuum of care,” Dr. Kansara adds. “I’m not just providing acute care. I’m not just part of the patient’s life or family for 30 to 45 minutes, and then it’s just goodbye, and I don’t know what is happening to that patient. For me, it is very gratifying to walk them through the journey during their acute phase of crisis, provide the best advice that I can, explain to them the best way I can, and even continue to do follow-up after their hospital discharge in a TeleClinic setting.”

Dr. Bhatt highlights that Providence’s TeleNeurology Stroke program stands apart from for-profit telemedicine companies, which often overlook smaller hospitals due to lower patient volumes. As a mission-driven organization, Providence is committed to caring for all communities, ensuring that every hospital—regardless of size—has access to high-quality neurological care.

“We don’t differentiate whether you’re a big hospital or a small hospital, whether you’re in the Portland metro area or whether you’re in middle Alaska,” Dr. Bhatt says. “Everybody’s getting the same type of care, and that’s important from the mission standpoint.”

Contributing caregivers

Archit C. Bhatt, M.D., is executive medical director, specialties at Providence.

Amit C. Kansara, M.D., is medical director, TeleNeurology at Providence.

Kitti Kaiboriboon, M.D., is medical director, TeleEEG at Providence.

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