Telestroke: There s an app for that Marc A. Lazzaro MD Assistant professor of Neurology and Neurosurgery Division of Neurointerven?on Director, Telestroke Program Medical College of Wisconsin tele STROKE
Disclosures No financial interest in any product or manufacturer men?oned herein.
Talk aims Highlight telestroke benefits Review selected literature Introduce networking solu?ons and sooware plaporms
Introduc?on Telestroke is emerging as a mainstream clinical stroke prac?ce in North America Technology has matured to a feasible, cost- effec?ve strategy Broadband internet Video compression technology Valuable addi?on to vascular and interven?onal neurology prac?ce
Uses of telestroke Stroke coverage in remote loca?ons Emergency stroke coverage Adjunc?ve coverage for local neurology prac?ce
Telestroke benefits More accurate decision making Higher rates of tpa administra?on Reduced costs within a network Improved collabora?on Increased compliance with metrics Streamlined pa?ent transfers Keep pa?ents at origin site when resources are adequate Transfer if higher level of care needed Accelerated clinical trial enrollment Expand endovascular therapy service
Accurate decisions, higher rates of tpa STRokE DOC trial 1 Efficacy of site- independent telemedicine A randomized, blinded, prospec?ve study 234 pa?ents randomized to telephone consult vs telemedicine Telestroke leads to More accurate decision making High rates of thrombolysis administra?on Low rates of intra- cerebral hemorrhage UPMC Telestroke network experience 2 Implementa?on of a telestroke network was associated with an increased rate of thromboly?c use in remote hospitals. 1. Meyer BC et al. Lancet Neurol 2008;7:787-95 2. Amorim et al. JSCVD. 2013.
Reduced costs Compared with no telestroke network, a telestroke system can result in: 1 More use of tpa and stroke therapies More stroke pa?ents discharged home independently Overall cost savings for the network of hospitals (despite upfront and maintenance expenses) 1. Switzer JA, et al. Circula?on. 2013;6:18-26.
Collabora?on, quality metrics A collabora?ve network for acute stroke care using ongoing data collec?on and review can lead to significant improvements in care. 1 Standardized protocols Ongoing data collec?on with review and feedback Ongoing training of origin site personnel Increase compliance with metrics Use of NIHSS Documenta?on for non- use of tpa 1. Stoeckle- Roberts S. et al. Joint Commission J Quality Pa?ent Safety. 2006 (32):9;517-527.
Improve clinical trial enrollment Many acute stroke studies are ongoing and enrollment is urgently needed. Recruitment into stroke clinical trials requires considerable resources and organiza?on. Clinical research team (24 hour coverage) Experienced inves?gators Duplica?on at mul?ple regional sites is not possible. Telemedicine can enhance enrollment into?me- sensi?ve acute stroke trials. 1 1. Switzer JA et al. A Telestroke Network Enhances Recruitment into Acute Stroke Clinical Trials. Stroke 2010;41:566-569.
Telestroke networking op?ons SoOware and hardware offerings vary Camera (mobile cart, remotely controlled robot, etc.) Provider interface (Desktop, laptop, mobile device) SoOware (single video conferencing system, combined imaging system, etc.) Adjunc?ve sooware capabili?es (data capture, best prac?ce recommenda?ons, document sharing, etc.)
Telestroke sooware plaporms InTouch Health JEMS Technology REACH telemedicine system BF Technologies Polycom Tandberg/Cisco LifeImage E?am
Network example ipad system
Network example ipad system Image sharing Video conferencing
Network example Image sharing Upload?me 6 min Provider access < 1 min
Network example Control func?ons Video conferencing Provider < 1 min access
Challenges in implemen?ng a network Technology Comprehensive sooware suite or separate programs IT support and infrastructure Creden?aling and licensure Reimbursement Establishing rela?onships
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