Telemedicine documentation in neurology and telestroke: a global scoping review

BACKGROUND: The rapid global expansion of telemedicine has created regulatory heterogeneity affecting documentation requirements, with particular implications for neurological services where documentation demands differ from general consultations. OBJECTIVES: To systematically examine documentation requirements for telemedicine across global jurisdictions, analyze convergence and divergence in regulatory approaches, evaluate specialty-specific requirements for neurology and telestroke, and explore liability frameworks for teleconsultations. METHODS: Scoping review following PRISMA-ScR framework. Comprehensive searches of academic databases and grey literature through August 2025, examining sources published, enacted, or updated after January 1, 2020. A composite regulatory intensity score was developed to enable systematic comparison across jurisdictions. RESULTS: Analysis of 147 regulatory sources across 52 jurisdictions revealed universal requirements for documentation elements while demonstrating substantial variation in consent documentation, data retention, electronic prescribing, and platform regulation. Regulatory intensity scores categorized jurisdictions across the full spectrum, with higher scores associated with more comprehensive documentation requirements. CONCLUSION: Telemedicine has transitioned from emergency contingency to regulated permanent care globally, with convergence on core principles but meaningful divergence in implementation specifics. Interoperability and mutual recognition rather than uniformity should guide regulatory harmonization efforts.