Telestroke: delivering stroke care virtually

We can see where health care is going. More and more procedures are automated and remote medical consultation and treatment is catching on. The goal is to make health care delivery faster, more efficient and cheaper. Recently, the American Heart Association published a policy statement that gave “recommendations for the implementation of telemedicine within stroke systems of care.”

Aside from the abovementioned reasons for implementation of telemedicine in general, here are a few specific reasons why virtual delivery of stroke care system may be necessary

There is a shortage of neurologists in many rural parts of the United States, making these areas underserved in terms of stroke care.
Even in urbanized areas, fewer neurologists are willing to provide 24/7 emergency room coverage for acute stroke care.

This calls for more creative and radical changes in stroke care that will work for patients and doctors alike and telemedicine seems to be the answer. Currently, telemedicine encompasses

In the specific case of stroke telemedicine (telestroke), the following

Patients and doctors are can interact through secure web camera video technology that allows remote yet rapid assessment of the patient but still protects patient confidentiality.
Medical history is provided remotely, mostly using electronic health records.
Neuroimages are displayed on the physician’s local computer and quickly interpreted
Diagnosis may be done using the so-called crowdsourcing diagnostics (see below for details)
If necessary, treatment including thrombolysis is ordered and monitored.

In fact, in many cases, telestroke diagnosis may prove to be more accurate than “face-to-face” diagnosis. Neurologists can use crowdsourcing diagnostics, a tool wherein doctors enter the symptoms and test results, and a computer software give the most probable diagnosis. This is almost like having access to the knowledge and experience of hundreds of health professionals, making diagnosis faster and cheaper.

Although telestroke is catching on, there are still barriers to overcome before telemedicine in general can become widespread and widely accepted. The authors of the policy statement have identified six major barriers.

(1) Defining medical specialties suitable for telemedicine

(2) Medical licensure and liability laws

(3) Securing the health information being shared

(4) Creating simple processes for requesting and performing the consultation

(5) Developing financial models for reimbursement of telestroke services

(6) Gaining acceptance of remote consultation from patients, physicians, and payers.

These barriers may be daunting, especially the legistation on medical licensure and liability, but the authors feel that they can be overcome with the right approach.