The University of Maryland (UMD) Medical Center in Baltimore will launch a new system Monday that will allow doctors to evaluate stroke patients in real time using interactive, two-way audio and video communication.
The patient image is so clear, according to a hospital press release, that a consulting specialist can see the dilation of a patient�s pupils. By using special computer software doctors can relay lab data, such as vital signs, blood type, and the status of a patient�s blood clot.
The lifesaving technology will allow stroke specialists at UMD Medical Center to evaluate patients at St. Mary�s Hospital, located more than two hours away in Leonardtown.
"St. Mary�s gets the expertise of a neurologist, which that county doesn�t have," said Marian LaMonte, a stroke neurologist at the University of Maryland Medical Center.
The new system can also transfer the data of a patient�s CT scan, which is mandatory to determine whether or not a patient should receive the stroke medication TPA.
TPA can stop a stroke in its tracks and can drastically decrease a patient�s chances of permanent severe disability, but it must be administered within three hours of an attack. In a 1995 National Institute of Neurological Disorders and Stroke study, 50 percent of stroke patients did not make it to the clinic in time to receive TPA.
Not all patients are candidates for the medication, however. TPA can be fatal to some patients, and that is something doctors need to determine from a CT scan.
In the February issue of the American Heart Association journal Stroke, two doctors recommend a system similar to UMD�s that they call Telestroke. That system would also benefit doctors at smaller community hospitals, or urban hospitals that don�t have stroke specialists on hand.
According to Steven Levine and Mark Gorman, Telestroke would work via two-way video conferencing, high-speed phone lines, and desktop computers to connect a stroke specialist with emergency room doctors and nurses in a small hospital. As a team, they could evaluate the patient, administer a stroke-assessment test, read the patient's imaging scans, and diagnose the type of stroke. The stroke specialist could also advise emergency room physicians as they administered medications or performed surgery.
"This is exactly the sort of approach that is going to have to be adopted if the morbidity of stroke will be lowered," said Douglas Perednia, president of the Telemedicine Information Exchange. "That�s because many strokes occur in places where immediate access to tertiary care services, such as catheterization, simply don�t exist. In these instances your best alternative is to try to relay the data and have the management plan relayed back, and initiate the plan while you still have time to do so."
The UMD Medical Center also completed a pilot project using telemedicine inside critical care ambulances for stroke patients.
"I can examine a patient [from the clinic] in an ambulance en route to our hospital and I see the patient on our desktop computer. As they�re coming to me I�ve already got their exam done, know their blood type, their vital signs, and I�m ready to treat them as soon as they come in the door," LaMonte said.
Over the past five years, interest in telemedicine has exploded, and doctors are finding that stroke patients could benefit the most from telemedicine. Levine and Gorman urge that clinical studies need to be completed to prove the telemedicine�s effectiveness to treat stroke.
"We�re going to study it and hopefully set up a consortium of investigators. In terms of it becoming a standard of care for practitioners, and to get everyone reimbursement for the services, clinical trials need to be done," Levine said.
As of 1999, the US Health Care Financing Administration is required to come up with rules that will allow them to pay for telemedicine in some circumstances, according to Perednia. Some states, like California, already require that HMO�s pay for some telemedicine.
