The Latest in Remote Presence.

Franklin, North Carolina is a town with just 4,000 residents, located on the historic Appalachian Trail in the southwest corner of the state. The town is famous for its gem mining, including rubies and sapphires. But this community has found something far more valuable: a life-saving connection to the Mission Health telestroke network.

Mission Health reached a major milestone recently when Dr. Alex Schneider, the program director in Asheville, used a remote presence robot dubbed “IC4U” to conduct the network’s 100^th telestroke consultation. The patient was at a facility in Franklin, a 90-minute drive from the hub hospital. Without access to a telestroke network, that patient would have lost 180 million brain cells just getting to Asheville.

The American Stroke Association estimates that only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be candidates for thrombolytic treatment. But the Mission Health program has an astounding 43 percent success rate.

“Treating our 100^th telestroke patient represents a momentous milestone for Mission Health,” says Schneider. “It’s evidence of the strides we are making in bringing timely, expert care to rural neighborhoods throughout western North Carolina.”

In its long history, Franklin, North Carolina has been home to Cherokee Indian councils and colonial era gem miners. But no sapphire discovery can compare to a program that offers Franklin residents an eight-fold greater chance of receiving timely t-PA treatment.

The Mission Health telestroke network serves Franklin, North Carolina, using a remote presence robot with this custom license plate.

Few would argue that the Mayo Clinic is the gold standard in healthcare research. The facility’s main campus in Rochester, Minnesota has been around since the 1890s and employs more than 32,000 people. So when Mayo recently published a study on the cost-effectiveness of telestroke care, hospital CFOs across the country paid close attention.

The study, published last month in Circulation: Cardiovascular Quality and Outcomes, concludes that telestroke programs indeed offer financial benefits, not just societal advantages. 

Using data from both the Mayo Clinic and Georgia Health Sciences University telestroke networks, researchers estimated that a rural hospital would save more than $100,000 annually compared to a hospital without telestroke capabilities.

“The upfront costs associated with setting up the telestroke technology are quickly offset by the financial gains that result from a higher proportion of patients receiving clot-busting drugs and the reduced stroke-related disability and subsequent reduced need for rehabilitation, nursing home care and assistance at home,” says Bart Demaerschalk, M.D., director of the Mayo Clinic Telestroke Program and co-author of the study. 

Most people assume that Mayo operates geographically close to its famous headquarters, but it also has a large footprint in Florida and Arizona. Mayo began using telemedicine technology in 2007 after research revealed that 40 percent of Arizona residents lacked local stroke expertise. Since its inception, the Mayo Telestroke Network has conducted more than 1,500 emergency consultations across the state.

“Previous studies have demonstrated that a hub-and-spoke telestroke network is cost-effective from the societal perspective,” adds Demaerschalk. “For a relatively small amount of money, [it] can save quality years of life – so it’s a bargain really.”

The Mayo study isn’t the first one to document the financial benefits of telestroke technology. But it’s nice when one of the best-known “brands” in American healthcare weighs in with its own convincing evidence.

Hoboken, New Jersey, USA – October 31, 2012

After Hurricane Sandy, we heard plenty of stories about heroic first responders from police and fire departments, not to mention the tireless utility crews. But there were plenty of tele-responders, too.

One New Jersey doctor went the extra mile to do a remote presence telestroke consultation – and there’s a man who probably owes him his life.

In the aftermath of Sandy, neurologist Robert Felberg was stuck without power at his Morristown. N.J. home. About the only thing working was his land line, and the call he received was urgent: an elderly patient at Holy Name Medical Center in Teaneck had just suffered a stroke and the ED doctor needed a teleconsultation.

Although Felberg was only 32 miles from the hospital, it might as well have been 3,000. Downed trees and power lines made travel impossible. So Dr. Felberg jumped in his pickup truck and started zig-zagging through neighbors’ yards. He finally found a strong enough 4G signal to do the teleconsultation. Felberg confirmed the on-site physician’s decision to initiate tPA. Within 48 hours, the patient was doing well enough to be discharged.

The InTouch Telemedicine System can be used from virtually any location.

Both Holy Name and Felberg’s own hospital (Overlook Medical Center in Summit, N.J.) never lost power during or after the storm because they planned ahead, making sure there was ample power from generators. “If there’s an award for bravery for prevention, these guys should get it,” he said.

That’s a theme echoed in a paper entitled “Tele-ICU During A Disaster” by Dr. H. Neal Reynolds and colleagues that ran in the Nov. 2011 issue of the journal Telemedicine and e-Health. The paper chronicled how an intensivist was able to stay in close communication with on-site hospitalists and nursing staff following a series of blizzards in Baltimore in 2009-10.

The article concludes that if a health system already has a telemedicine network in place, the organization can simply extend those capabilities to disaster support when needed. But the key is to be prepared. If Holy Name hadn’t established a remote presence network in the first place, Dr. Felberg’s gallant efforts would have fallen short.

As police and firefighters know, bravery will only get you so far. Teleheroes – like all first responders – need to be ready in advance.

To read a full account of the story in the New Jersey Star Ledger, click here.

Information provided by the U.S. Centers for Disease Control and Prevention.

We’re all aware that the number of strokes per year in the U.S. is about to cross the 800,000 threshold, but it’s shocking to see how much of that is concentrated in the Southeast region.

Just take a look at this map of the “Stroke Belt” to see how bad it’s gotten in Dixie. It makes you wonder what folks in Phoenix, Minneapolis, and Albany are doing right – and why that success can’t be repeated in the South.

When you take a closer look, you’ll see that many of the nation’s stroke “hot spots” are in underserved areas like northern Maine and in rural parts of the Pacific Northwest. But the South is where you see ample evidence of a double-whammy: a large number of rural communities that don’t have access to advanced stroke care, plus the nation’s highest rates of obesity and high blood pressure.

You’d think that most hospitals in the Southeast would be staffing up on stroke specialists left and right, but many simply can’t afford the high cost of on-site neurointensivists. That’s why telemedicine has such a huge role to play in turning the Stroke Belt into the Southern Success Zone.

Although some sections of the country are more stroke-prone, that doesn’t diminish the need for telestroke capabilities in every community. New Mexico may have enviable stroke statistics, but that doesn’t mean much to someone experiencing a possible stroke in a small town like Portales or Hobbs. Survival trumps statistics every time.

This map makes one thing crystal-clear: hospitals in the South must implement telestroke programs with an urgency akin to D-Day. This year, the number of stroke deaths will be enough to fill two NFL stadiums. That’s totally unacceptable. It’s time to declare war on stroke, with telestroke programs leading the charge.

Health reform has given us a lot of buzzwords like “accountable care” and the warm-and-fuzzy “medical home.” They try to capture the essence of where reform is taking us: to a patient-centered system where collaborative care provides higher quality, better outcomes and lower costs. By tearing down silos and eliminating redundant tests, everybody wins.

That’s the grand vision anyway. But many healthcare organizations are having a tough time making the transition to this new approach.

To see how collaborative care is supposed to work, just look at the new telestroke program at the University of Cincinnati Neuroscience Institute and University Hospital. This teaching facility has long been in the top 25 of America’s academic medical centers – and the UC Stroke Team was started way back in 1987.

The new telestroke program is powered by ITH’s Remote Presence technology, connecting UC stroke specialists with physicians at UC Health’s West Chester Hospital and Dearborn County Hospital (just across the state line in Lawrenceburg, Indiana).

Here’s how the telestroke program meets the “triple aim” of health reform:

Higher quality care – Patients are quickly examined by a stroke specialist who can see and hear them right at the bedside.

Better outcomes – The program will save more lives – and provide higher quality of life – thanks to faster intervention and greater teamwork.

Lower costs – With Remote Presence, only the most severe stroke cases need to be transported to expensive tertiary centers – and many more patients can remain in facilities close to home.

“This is an important advance for us, and more importantly, for our patients,” says Dr. Opeolu Adeoye, director of the UC telestroke program. “This will allow them to stay closer to home at partner hospitals while still receiving the most advanced care available.”

Those words are almost like a mission statement for health reform. In the old paradigm, there would have been a number of time-squandering steps: local triage, transport to a stroke center, repeat diagnoses. But with telemedicine, the ED doctor, specialist and patient are all communicating in real-time.

Telemedicine is helping providers reach consensus in minutes, not hours. That’s what industry pundits call “collaborative care” – and what stroke survivors call a “miracle.”