Technology has changed how we practice medicine. Legislation such as the Health Information Technology for Economic and Clinical Health Act signed into law in 2009 incentivized health care providers to utilize electronic medical records (EMRs). Since these regulatory changes, use of EMRs and other technologies has increased substantially. The COVID-19 pandemic accelerated the utilization of technology through the routine use of telehealth. This theme issue of the International Journal of MS Care (IJMSC) focuses on how use of technology can improve our understanding of multiple sclerosis (MS) and augment multidisciplinary neurological care.
The EMR has many capabilities to aid patient and clinician communication regarding medical care. Prior to the digital medical record, the only way for patients to interact with their care team was through office visits or telephone calls. Most EMRs have incorporated messaging portals, such as MyChart in Epic. In this issue, Khalil et al characterized the utilization of MyChart messaging among patients with MS. The authors found that MyChart utilization was high (74%) but was utilized more by younger individuals with less disability and shorter disease duration. Although it is promising that EMR messaging portals may improve communication between patients and their care team, it is important to acknowledge potential disparities in utilization. Prior to the EMR, most observational research studies were conducted using databases that were distinct from clinical documentation. EMR platforms that have integrated MS-specific features have improved documentation, allowing better clinical characterization of patients for routine care and facilitating research efforts. Swetlik et al provided a narrative review of the currently utilized EMR platforms and highlighted ways the resulting data can improve understanding of the disease.
Telehealth for MS care became routine during the pandemic. Facilitators and barriers to use must be better understood to ensure equitable health care delivery. Roth et al evaluated perceptions of telehealth in a qualitative study of patients with MS and health care providers. The study affirmed that telehealth provides efficient, convenient MS care, but optimization of telehealth protocols and legislation are needed to sustain long-term utilization by all stakeholders. Keszler et al also highlighted that synchronous telehealth visits were associated with high satisfaction for health care providers, again supporting the need to better understand long-term integration.
High-quality MS care requires a multidisciplinary approach that includes providers such as neurology clinicians, rehabilitation specialists, mental health providers, and social workers. This care model ensures a holistic approach to MS care. Although many centers worldwide have developed robust in-person approaches, multidisciplinary telehealth models must be developed to improve access to complete MS care. Zimmerman et al reported results of a virtual wellness program for patients with MS: participation was associated with improvements in emotional well-being, pain levels, mindfulness, and exercise habits. These results are promising as telehealth wellness approaches may improve access to beneficial programs to improve the quality of life for individuals with MS. Similarly, Gerritzen et al accessed the impact of online peer support for patients with MS. This systemic review suggested the benefit of reduced social isolation for individuals not able to access in-person support groups but highlighted the need to improve quality of information in these groups and further identify barriers to utilization. Finally, Gopal et al evaluated the utilization of telerehabilitation and found that it reduced travel burden and facilitated scheduling flexibility when compared with in-person visits. They also identified barriers to its use including technology literacy, cognitive impairment, and fall risk.
This IJMSC theme issue highlights the increasing integration of technology into MS care. All the studies included demonstrate the significant potential for technological innovation to improve access to high-quality multidisciplinary MS care while also improving the characterization and understanding of the disease. Although these are clear advantages to technology, all the authors highlighted potential barriers to implementation, adoption, and equitable utilization. As care models evolve, studies are needed to characterize the impact of technology on MS outcomes, costs, satisfaction, and the preferences of patients. A rigorous approach to developing hybrid delivery models is needed to ensure improved access to care and better outcomes for all patients with MS.