Telemedicine Process
Overview
The telemedicine system has two components: a brain imaging review and a remote examination via video conferencing.
Interpretation of the brain images (CT scan) is a vital part of the acute stroke evaluation. The brain imaging review allows an MGH physician to download and view brain scans from the remote hospital. Since the scans are available, the MGH physician may be able to see subtle findings in a stroke patient that might not be seen by a less experienced eye.
"Its great to have people from Partners literally walking us through the exam so we can get these patients to a tertiary center as quickly as possible."
Dr. Gerald Yukevich
Martha's Vineyard Hospital
The video conferencing component lets the physicians collaboratively perform the NIH-MGH Stroke Scale, which represents the severity of the stroke and supports a diagnosis of stroke that may lead to further treatment.
This informed consult lets physicians recommend treatment quickly and in stroke care, as Dr. Schwamm describes it, "Time is brain".
Aside from the software, all of the technical components are commercially available. The video and the sound components travel over three high speed, ISDN telephone lines and utilize data compression technology to transmit the images.
A Sample Case
A patient presents to the remote hospital's ED with a possible diagnosis of acute ischemic stroke. The local stroke team is activated and brain imaging is performed. The patient is then considered for remote consultation. This patient might be a candidate for thrombolytic therapy, utilizing either intravenous (IV) or catheter based methods, or someone in whom acute stroke expert management consultation is desired.
If remote advice is desired, the patient signs a consent form allowing them to be evaluated over the video conferencing system. This authorization is forwarded to your provider and kept on file.
With the help of the referring ED, the stroke specialist conducts a brief neurological exam of the patient. Upon completion, they then review the brain imaging. The findings are discussed with the remote physician and together they collaboratively decide on a plan of care.
The acute stroke evaluation and recommendations are placed on the secure TeleStroke Center web site, where the referring physician can access them. This document can be printed and placed in the patient's medical record at the referring facility.
Follow-up consultation is also available for further treatment decisions and secondary stroke prevention recommendations.
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