The article originally appeared in the Jan./Feb. edition of INTERNET TELEPHONY.
When a person suffers a stroke or concussion, there’s a narrow window of time during which doctors can act by administering clot-busting medications to minimize permanent injury to the brain. Now, mobile and videoconferencing technologies are making it possible for a larger segment of the patient population to have expedited access to neurologists and other health care professionals, making it possible for them to diagnose and, if needed, recommend treatment for such time-sensitive medical emergencies. The Mayo Clinic in Arizona, as state in which 40 percent of residents live outside areas with stroke expertise, is one organization that’s putting these technologies to such use.
Mayo Clinic has created what it calls the Telestroke Network, which connects the Phoenix facility with 12 rural hospitals in Arizona and Missouri. That includes facilities in Bisbee, Casa Grande, Cottonwood, Flagstaff, Globe, Kingman, Parker, Show Low, Tuba City, Phoenix, and Yuma, Ariz., as well as one in St. Joseph, Mo.
"This telestroke partnership between our physicians and Mayo Clinic means our Navajo and Hopi patients can now have immediate high-tech, state of the art stroke care," said Joseph Engelken, CEO of Tuba City Regional Health Care, a north central Arizona facilities that was scheduled to come online toward the end of 2012.
"Urgent and immediate virtual care can be provided to patients — collaboration between stroke neurologists and physicians at the remote sites has resulted in 96 percent accuracy in diagnosing stroke," Bart Demaerschalk, M.D., professor of neurology, and medical director of Mayo Clinic Telestroke.
Videoconferencing devices, including video-enabled robots, are used to connect patients and health care workers at remote hospitals with neurology specialists working from computers in Phoenix. To date, Mayo Clinic neurologists have done more than 1,000 online, face-to-face telestroke evaluations using this solution, and the program recently expanded to address other maladies, including concussions.
The telestroke solution also can be used for related types of interactions, some involving smartphones. For example, Mayo Clinic neurologists recently worked with emergency physicians and radiologists at Yuma Regional Medical Center to compare brain scan images from 53 stroke patients that visited the Yuma location. There was a high level of agreement on the interpretation of images and scans, whether viewed in person or via smartphone, according to a study funded by the Arizona Department of Health Services with technical assistance by Calgary Scientific, the maker of ResolutionMD.
"Smartphones are ubiquitous, they are everywhere," said Demaerschalk. "If we can transmit health information securely and simultaneously use the videoconferencing capabilities for clinical assessments, we can have telemedicine anywhere, which is essential in a state like Arizona where more than 40 percent of the population doesn't have access to immediate neurologic care."
However, while technology now makes it possible to connect far-flung medical professionals and patients, there are often significant barriers to the adoption of telemedicine, according to study by researchers from Mayo Clinic in Arizona, C3O Medical Group in Ojai, Calif., and UCLA Medical Center in Los Angeles. Impediments to telemedicine deployments include licensing restrictions; the administrative burden of giving physicians privileges and credentials to engage in telemedicine and lining up malpractice insurance; and limitations in ability for billing and reimbursement, according to the study.
"Fortunately, the majority of respondents indicated that the technology itself, obtaining buy-in from health care administrators and the culture were not barriers to telemedicine," said Demaerschalk, who added that “the researchers in the study encourage those government and non-government insurers to more liberally reimburse for telemedicine consultations the same as they would for face-to-face care – particularly for acute robotic telemedicine consultations where there is proven reliability, validity, safety, clinical efficacy and cost-effectiveness."
Research is published in the Sept. 14, 2011, online issue of Neurology, the medical journal of the American Academy of Neurology, indicates the telestroke is indeed cost-effective for rural hospitals that don't have an around-the-clock neurologist, or stroke expert, on staff. Again, Demaerschalk was involved in this research; in fact, he was the co-author of the study, which indicates that the incremental cost effectiveness ratio for telestroke over a person's lifetime is less than $2,500 per quality-adjusted life year. The threshold of $50,000 to $100,000 per quality-adjusted life year in the U.S. is commonly cited as the cut-off for cost-effectiveness, according to the study.
"The results convincingly demonstrate that telestroke is cost effective compared to the usual model of care," he said. "It's only a tiny amount of money ... comparatively, telestroke costs a couple thousand dollars more to save quality years of life – so it's a bargain really."
He added: "If the costs associated with the technology are reduced or if reimbursement opportunities increase we will recognize that this treatment modality may, in fact, save money,"
That’s not to mention the life-saving and quality-of-life gains that both telestroke and teleconcussion capabilities can deliver for people of all ages.
Philip Johnson, M.D., is the medical director and chair of emergency medicine at Summit Healthcare in Show Low, commented: “This is a lifesaving thing. To use this modality to reach out across the state to deal with concussions fulfills a great need. In our emergency room, I see one to three concussions a week, and I send the patients out with instructions to follow up with their doctors, and I know that without a neurologist in our little area here that follow up doesn't always happen as it should.
"During the evaluation with Mayo Clinic, it was really exciting to have this patient evaluated here locally,” Johnson added, “and he will be able to go back to playing soccer when he really should."
Edited by Stefania Viscusi