Digital divide hampering the proliferation of Teleneurology

nrneurol.2018.31-f1Teleneurology refers to the use of technology to provide neurological care,  ranging from the the use of educational programs and remote monitoring, to the simplicity of  telephone call enabled ambulances. The recent decade has seen a rise in the use of teleneurology, mirrored by the increased research output (see figure 1), most likely deduced to its unique ability to increase access to care, especially in the context of low and middle-income countries  (LMICs)[1]. Following the emergence of telehealth, teleneruology also advocates for the expansion and migration for care delivery from more traditional locations, such as hospitals and clinics to homes and devices – such as mobile phones and wearables. 

“The number of e-mails, phone and video encounters now exceeds the number of in-person clinic visits”

-Dorsey et al, 2018


Precision Global Health in practice: Teleneurology

Project ECHO 

Launched in 2003, the ECHO model makes specialised medical knowledge accessible wherever it is needed to save and improve people’s lives. By putting local clinicians together with specialist teams at academic medical centers in weekly virtual clinics or teleECHO™ clinics, Project ECHO shares knowledge and expands treatment capacity [2].  “The heart of the ECHO model is its hub-and-spoke knowledge-sharing networks, led by expert teams who use multi-point videoconferencing to conduct virtual clinics with community providers. In this way, primary care doctors, nurses, and other clinicians learn to provide excellent specialty care to patients in their own communities” [2].


ParkinsonNET is an integrated care network, which adopts the personalised model for care of delivery focused on decision support for clinical practice. The network also supports educational programs, focused on: improving the quality of care for Parkinson’s (PD providers), improving the ability to self manage care (PD patients and spouses), and network based healthcare. More recently ParkinsonNET launched ParkinsonTV, which gathered  neurologists, dieticians and therapists for live educational programming, with the ability to ask questions in real-time [1,3].




Although the cost of mobile broadband has decreased by 60% since 2013, the digital divide still presents itself as a major obstacle for increased access to neurological care [1].  Internet access and connectivity still remain a huge problem in LMICs, with internet access at 50% – and less than one third in Africa. Additionally,  there are still a number of concerns regarding remote-experts familiarisation of the local setting, considering factors such as resource availability and cultural conditions [1]. Increased solutions bridging last-mile connectivity from a bottom-up approach must be integrated into care networks to fully benefit from the potential of teleneurology.


We’d love to hear your thoughts and opinions in the comment section below. 



[1] E. Ray Dorsey, Alistair M. Glidden, Melissa R. Holloway, Gretchen L. Birbeck & Lee H. Schwamm. (2018). Teleneurology and mobile technologies: the future of neurological care. Available: Last accessed 04/05/2018.

[2] University of New Mexico . (2018 ). Project ECHO . Available: Last accessed 04/05/2018.

[3] ParkinsonNET. (2014). ParkinsonNET: About . Available: Last accessed 04/05/2018.

Written by Nefti-Eboni Bempong

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