How Telemedicine is Changing Stroke Treatment

January 04, 2016

One of the greatest challenges in treating acute stroke is the time it takes to deliver victims to stroke specialists, especially when the victims are far away. Neurologists often refer to the expression "Time is brain," meaning that from the onset of stroke, the potential for permanent disability or death increases with every minute. Historically, people who lived hours away from qualified medical centers were simply unable to access the highest level of care, and thus at much greater risk. However, with the increasing adoption of telemedicine in stroke treatment, access to a specialist's assessment and prescribed plan of action requires just the flick of a switch.

A telemedicine network connects patients and their attending physicians at faraway "spoke" locations to stroke specialists at "hub" locations via two-way live video/audio feed and image sharing technology to support diagnosis and treatment for optimal patient care. It also provides a resource that allows for streamlined transfer of patients who may require the services of a more comprehensive center with greater technical capabilities.

In many cases, it is an actual mobile robot at the spoke location that facilitates the exchange. The patient and attending physician interact with the hub neurologist in a manner much like that conducted in any bedside exam. The neurologist may maneuver the robot using a joystick or tablet computer. The robot's zoom lens allows the neurologist to evaluate even the patient's pupils and eye movements.

While telemedicine is a relatively new mode of medical practice, it is already paying great dividends. The Dignity Health Telemedicine Network was first launched in 2008. As of 2015, it has performed more than 14,000 telemedicine consults throughout 39 facilities in California. In addition to neurological consultations, the network has also assisted in psychiatry, intensive care, and other medical specialties.

Given this early success, physicians and medical device manufacturers are finding new ways to incorporate telemedicine. Some emergency medical technicians and other first responders are now using mobile devices (something that looks like a heavy duty iPad) with a wireless internet connection to initiate telemedicine consultations from on-site or in transit so as to evaluate the patient's condition and alert the hospital of an incoming stroke patient who will need a prepared and rapid response.

In many cases, telemedicine enables quick administration of life-saving, clot-busting drugs under remote supervision before transporting the patient, greatly increasing the odds of a favorable outcome. The fire department in Folsom, California began participation in the Dignity Health Telemedicine Network in September 2015. Having performed more than 25 prehospital evaluations, preliminary results are very positive. In a very real sense, telemedicine is transforming the way we treat stroke and bringing much needed expertise to patients regardless of where they are.

Dr. Alan Shatzel is a Dignity Health neurologist in Sacramento, California-helping stroke patients at Mercy General Hospital, Mercy San Juan Medical Center, Mercy Hospital of Folsom and Methodist Hospital of Sacramento. He is medical director of the Dignity Health Telemedicine Network and the Dignity Health Neurological Institute of Northern California.

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