Clinical Telemedicine Blog

SOC Teleneurology Team Thanks EMS Personnel

By Amy Levitt

Medical equipment on isolated black background, horizontal.jpeg

It’s National EMS Week and Specialists On Call would like to take this opportunity to thank all Emergency Medical Services personnel for their vital public service and positive impact they have on the survival of anyone who experiences sudden injury or illness. We’d like to especially say thank you for their contributions to early recognition of stroke. For more than half of all stroke patients EMS is the first medical contact they have. These patients are dependent upon EMS personnel’s ability to accurately and quickly recognize the signs of stroke and get them to a neurology specialist who can prescribe life-saving treatment.

Due to the short eligibility window for administering tPA, EMS responders and SOC’s TeleNeurology service are essential to the quality of stroke care.  Since there’s almost no way for EMS personnel to know precisely when the symptoms started, it’s even more critical that they transport the patient to a hospital that can guarantee a neurologist available for consult. Specialists On Call is the largest provider of teleneurology care in the world, with over 4,000 patients treated every month and more than 200,000 consultations performed to date. In many instances, even with a 15 minute response time, we still wouldn’t have had the opportunity to see and save a patient were it not for the expertise and fast thinking of the EMS responder.

To all Emergency Medical Services personnel: thank you. We recognize and honor you during National EMS week as well as the remaining 51 weeks a year.  We look forward to continuing our collaboration in improving stroke care.

Contact us to learn more about how we can help improve stroke care in your hospital.

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, stroke awareness, Emergency Medicine, Neurologic Emergency, Neurologic Emergencies, SOC, emergency departments

Teleneurology Provides Rapid Response from a Top Level Neurologist

By Jeff Simer

Two weeks ago I had the pleasure of attending the Society of Interventional Radiologist CLOTS training course in Dallas TX. The course is staged as a comprehensive five-day training course is composed of in-depth multidisciplinary lectures emphasizing the entire spectrum of stroke diagnosis and management.

The conference was centered around the minimally invasive approach to advanced ischemic stroke intervention and all of the management considerations, along with this, there was a full suite training course on the various techniques and medical device technology-from imaging to the catheter based solutions to intervention.

There were many presentations at the meeting, presenting many findings from some of the luminary interventional programs in the U.S. and Europe. 

Several presentations focused specifically on the overall process in which acute ischemic stroke is identified, triaged, processed, and managed on a systemic level.  This approach is generally considered a “Hub and Spoke” a model of developing a transfer pattern with in a defined geography where institutions that do not have in-house interventional capabilities can efficiently refer the appropriate cases to the “hub” for the advanced procedure that would not be able to be performed in-house at the originating site.  This model is particularly attractive to the interventional team as the number of in-house cases that present are generally not in sufficient numbers to fully support and justify the cost burden of a full swing interventional program. 

SOC attended this course in order to bring attention to one of the key issues that hinders these programs from realizing their growth potential-Acute Emergency Neurological consultation in the ED.  All interventional programs depend on the neurology staff of any given institution to identify candidates for both IV lytics, medical management, and in most cases, those that would benefit from advanced intervention in a bi-plane suite.  Many community level hospitals do not have 24/7/365 neurology to cover ED stroke call.  Even those that do, do not have the ability to respond to stroke codes within the “window” that stroke cases require to capture the opportunity for either lytics administration or intervention.  Hence the emphasis on how to create a network of hospitals that can feed an interventional practice.  This window is often lost due to the response times from the local specialists.  The lytics window is up to 4.5 hours for IV, and 8-12 for endovascular therapy.  The SOC specialists are guaranteed to respond in 15 minutes or less, thereby shortening the time that is lost waiting for a specialist to give an opinion on the case. 

Many Interventional programs lack the depth of call and expertise to provide such rapid response to neurological emergencies in the community setting.  With that said, many of the institutions that develop partnerships as “hub and spoke” lose momentum as the neurological consulting staff is not deep enough to provide 24/7/365 call coverage in a consistent and rapid fashion-burn out ensues and the network loses its effectiveness.  As a result, many of the partners lose confidence in calling for consultation and revert back to just sending all cases to the tertiary center.  This is neither good for the patient nor the receiving hospital, as the vast majority of cases are ones that can stay at the originating hospital and need not be transferred away from the community.  The receiving hospital is then using resources to manage patients that could have been kept at the partner site and not using the resources for advanced care. 

SOC had Dr. Heather Linn present on the history of SOC, the methods and value that having the availability of rapid response from a top level neurologist.  She articulated to the audience how 15 minute response time, along with the correct information has allowed SOC doctors to deliver more front line acute stroke care than any other neurological practice in the U.S.  Because SOC physicians are all fellowship trained and also well versed on the available interventional treatments available in most tertiary centers, SOC is uniquely able to assist both hubs and partner hospitals in tending to the extremely time sensitive nature of acute ischemic and hemorrhagic strokes.  With that said, there was considerable interest from the interventional field in how SOC can partner in assisting the flow and triage of patients that are appropriate candidates for advanced neuroendovascular procedures.  The body of specialists I spoke to were blown away with the volume of cases that the SOC physician staff has responded to, on average over 10,000 a year.  Further, they were also impressed with the ability to appropriately manage and in many cases recommend treatment for these critically ill patients. 

I very much enjoyed the presentations I attended and want to thank everyone that stopped by the booth and asked questions or for more information.  It is clear that there is high value in utilizing the SOC solution as a key component in an advanced neuro-rapid response outreach program.  I look forward to seeing more partnerships with SOC as an integral part of advanced Neuroscience initiatives.

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, healthcare, Emergency Medicine, Neurologic Emergency, Physicians, Neurologic Emergencies, telemedicine solutions, Specialists On Call, SOC, hospitals, emergency departments, emergency department, On Call Coverage, Telepresence, Patients, telehealth, neurologists, telestroke, Efficiency, CLOTS, Society of Interventional Radiologist

World Stroke Day - Learn the Warning Signs of a Stroke

By Joe Peterson, M.D.

Warning signs of stroke1 in 6 men and 1 in 5 women will experience a stroke in their lifetime; Every two seconds, someone in the world suffers a stroke; Every six seconds, someone dies of a stroke; Every six seconds, someone’s quality of life will forever be changed – they will permanently be physically disabled due to stroke.

 

Today is World Stroke Day, a day dedicated to promoting stroke awareness.  SOC is proud to be one of the companies helping to fight this epidemic. There are 800,000 strokes a year in the USA; approximately one of every 50 is evaluated by a SOC physician.

In honor of World Stroke Day we want to remind you of the tremendous work we do made possible because of the amazing employees, partners, hospital partners, and physicians we work with. Consider that, with your help, SOC:

  • Provides 24/7/365 on-call emergency teleneurology coverage for 225+ hospitals in 23 states
  • Delivers over 2,000 emergency teleneurology consultations each month
  • Has conducted more than 55,000 emergency teleneurology consultations in less than 6 years – more than any bricks and mortar medical facility in the country
  • Delivered 13,000+ stroke consults per year
  • Oversaw the administration of t-PA 900+ YTD 2012

Knowing the warning signs and getting someone who may be suffering a stroke to the hospital quickly allows them to be assessed for the clot-busting drug t-PA, which may reduce disability or death from stroke. An easy way to recognize the sudden signs of stroke is to remember FAST:

F – Face - can the person smile?
A – Arm - Can the person raise both arms?
S – Speech - Can the person speak clearly and understand what you say?
T – Time - Act FAST!

By simply educating yourselves and your families on the signs and symptoms of stroke and seeking immediate treatment, together we can make a profound improvement in the care of stroke patients across the country!

 

        Joe Peterson, MD

JP Signature

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, stroke awareness, healthcare, Emergency Medicine, Neurologic Emergency, Physicians, Primary Stroke Centers, Neurologic Emergencies, World Stroke Day, telemedicine solutions, warning signs of stroke, FAST test for stroke, Specialists On Call, SOC

Alabama Broadband & Telehealth Summit Recap

By Sam Klement

Last week I had the privilege of attending this 1st annual symposium which had over 225 people in attendance.  To say this inaugural event was a success would be a gross understatement! I personally spoke with folks from as far away as Texas and many other states including Mississippi, Georgia, Louisiana, Kentucky, Florida and more. Dr. Stephen Suggs, Specialists On Call Teleneurologist, presented a very well received session that highlighted 5 Impacts of Telemedicine to Prattville Baptist Hospital (you can get the executive summary here.)

I was also able to attend other sessions including those by Ron Sparks, Senator Taylor, Dr. Carl Taylor, APT COO Dr. Jeffery Kesler, and Executive Director of Connecting Alabama Jessica Dent. There is a lot of commitment to bring the GPT model to Alabama and to get telehealth reimbursed for all payers. The overall messages resonated with SOC’s focus on patient care – connecting patients with the right doctor when they need it.

My goals for attending the conference were to learn everything I could about the APT initiative, hear from thought leaders in Alabama, and meet some of our SOC partners. I also wanted to let the other attendees know that SOC is the leader in telehealth and that we have a local representative. I feel like I accomplished it all!

Thanks to everyone that came by the SOC booth and especially to those that were singing the SOC praises loud and proud! I look forward to attending again next year!

Topics: telemedicine, teleneurology, telepsychiatry, telehealth, Alabama Broadband & Telehealth Summit, GPT

Telemedicine Made Personal

By Amy Levitt

Most televised reunions are gimmicky and superficial, but there was nothing trivial about the reunion of Sandra Bowden and Todd Samuels, M.D., at this year’s American Telemedicine Association (ATA) annual meeting in Tampa.

What the “Human Touch of Telemedicine” conference video crew captured that day was a vision of our medical future: a teleneurology advocate and stroke patient from Texarkana, Texas, getting to meet the neurologist who assessed her from his office in Baltimore, Maryland—and helped improve her outcome and recovery time. Here, in her own words, is Sandra Bowden’s account of her very personal introduction to the benefits of teleneurology.

Telemedicine Made Personal

There are many ironic moments in life, but few that compare to my stroke assessment last year.

I am director of medical post-surgical services at Christus St. Michael Health System in Texarkana, Texas—a city perhaps best known for being the hometown of one-time presidential candidate Ross Perot. Although our facility includes a 312-bed acute care hospital, Texarkana is still a fairly small city—ranking 288th in the latest U.S. census. We don’t have as many local neurologists to call as do hospitals in Boston or Los Angeles. For that reason, teleneurology has played a key role in our hospital’s campaign to become a certified stroke center.

In 2010, during an early morning meeting with the Christus stroke team, I began to feel a tingling sensation in my ear and face. It spread down my left arm, and a colleague noticed that the left side of my face was starting to droop. She quickly escorted me to the ER, where the doctor ordered a CT scan. By the time I returned to the ER, Specialists On Call, our recently implemented teleneurology provider, had been notified and neurologist Todd Samuels was speaking with my physician.

With the help of the attending nurse, Dr. Samuels began a complete neurological assessment. Throughout the entire consultation, I was the center of his attention. He answered all the questions my husband and I had, and made us both feel comfortable during a very difficult time.

Dr. Samuels told me that he believed I was having a stroke that would respond well to the clot-busting drug called tPA. He also explained the risks and benefits of the therapy. I assumed he would order the drug and be done, but he stayed and checked in on me. In a short time, I started having resolution of my symptoms—and Dr. Samuels seemed very pleased with the outcome.

I was soon transferred to the ICU, where my condition steadily improved. The left side of my face continued to droop for a few days, and I had some minor issues with gait and balance. But physical therapy resolved those conditions, and today I live a normal life with no deficits.

So when I attended the ATA annual meeting earlier this year, I had no idea that I would be meeting Dr. Samuels in person. It was a complete surprise to me. I knew I’d never forget his face, and it was wonderful to express in person how grateful I was. I couldn’t have asked for higher quality care.

I have long been a teleneurology advocate, but it wasn’t until I was the recipient of this innovative approach to care that I completely understood its importance. This is the way that medicine is going. We already have far too few specialists to meet the growing needs of people in areas of the country like mine. But I’ve experienced first-hand how teleneurology can help solve the specialist shortage and offer wonderful, life-saving care. After my encounter with SOC, I more firmly than ever see telemedicine as the wave of the future.

--Sandra Bowden, RN-BC, MSN

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, hospitals, telestroke, Uncategorized

Emergency Medicine Excellence Award Goes to 7 Top Performing Florida Hospitals

By Amy Levitt

Author: Joe Peterson, M.D.

The First Annual HealthGrades Emergency Medicine in American Hospitals Study examined more than 5 million Medicare records of patients admitted through the emergency department at 4,907 hospitals from 2006 to 2008. It then identified hospitals that performed in the top 5% in the nation in emergency medicine. Healthgrades is the leading independent healthcare ratings organization.

The study was based on risk-adjusted mortality outcomes for patients admitted through the emergency department for 11 of the most common life-threatening diagnoses in the Medicare population, including stroke. Comparing the group of hospitals in the top 5% with all the others, HealthGrades found that the top group had a 39% lower risk-adjusted mortality rate.

Florida had the second highest number of facilities to win the award, including 28 top performing hospitals in-state—a quarter of them employ Specialists On Call’s teleneurology service. The 7 Florida hospitals are Bethesda Memorial Hospital, Florida Hospital Orlando, Jupiter Medical Center, Ocala Regional Medical Center, Wellington Regional Medical Center, West Marion Hospital and Wuesthoff Medical Center Rockledge.

Carole DiFlorio, the chief nursing officer at Wellington Regional Medical Center commented, “We introduced teleneurology many years ago to our community and it’s been a welcome addition to the services we’re able to provide. Specialists On Call delivers a methodology by which we can bring the best services to our community in the most timely fashion and immediately help our patients suffering any neurologic emergency. It’s a big part of why our emergency department has had so much success in receiving, evaluating and treating emergency patients.”

Congratulations to our Florida winners!

For more information on HeatlhGrades, visit www.healthgrades.com.

Topics: Stroke, teleneurology, Emergency Medicine, Neurologic Emergency, hospitals, Uncategorized, HealthGrades

Teleneurology as a Model for Telemedicine Growth: Part 2

By Amy Levitt

Author: Joe Peterson, M.D.

Teleneurology as a Model for Telemedicine Growth
The old lessons that have proven true in this new medium called telemedicine are primarily clinical ones. Quality, as Ford once said, has to be job #1. It has to be built into operating systems and managed as, or more aggressively with, distributed groups of physicians, as it does in traditional bricks and mortar institutions. There should be no reason that providers of physician services at a distance enjoy any holiday from the same accepted quality and privacy standards that traditional institutions are held to: Joint Commission accreditation, HIPAA compliance, etc. Of note, the fact that connecting to physicians remotely requires an electronic flow of information does give telemedicine a leg up in managing quality. As every patient’s case has to be committed to a system in order to be communicated to a distant facility, then that data is by definition accessible for real time review and monitoring. For example, adherence to best practices and accepted protocols are simple to measure in patient care decisions being communicated real-time through a single data system. Similarly, the logging of real-time actions into a single data system allow the review and measurement of the time required or delayed during progress against a diagnostic or clinical plan—it’s a great way to define the actionable inefficiencies in a clinical operation.

Like quality, patient satisfaction remains a prerequisite not only for good care but also for the most efficient care. Investments in telemedicine-based efficiency actually allow telemedicine-based interactions to devote more time to the patient interaction—always a factor in patient satisfaction—simply because local logistical factors have been washed from the physician’s day. This has been a happy and unexpected side effect of telemedicine. A well organized service leaves the physician with more time to speak to patients and a better ability to remain “on schedule” throughout the day, leading to many more “thank yous” than physicians working over this new medium were accustomed to receiving in the course of their traditional practice.

Teleneurology has taught new lessons about the actual role of technology in the patient interaction; enough patients have been seen that there is a body of experience now built directly from thousands of patient care interactions. One is the clear lesson that technology alone is not a solution, it’s a component. Despite the great potential of telemedicine as an adjunct to traditional care strategies, there’s a very large amount of videoconferencing equipment that was purchased with grant money and now sits in a closet covered with a dusty ER blanket. This happens because there’s a great deal more steps required to efficiently connect patients and physicians, in real time, than a couple of videoconferencing endpoints.  Teleneurology has taught us that real people and technology infrastructure—not isolated equipment purchases—are what’s required to capture the efficiencies promised by the concept of telemedicine.

Another lesson learned from these thousands of patients is that they are much faster to accept change than the physician community. As long the quality of the technology ‘connections’ are good and the service is executed with obvious professionalism, patients are accepting this new delivery mechanism and have moved on in their internal review and acceptance of telemedicine as a delivery vehicle for good care.

I was reminded very directly of this earlier this month while interviewing a family about their telemedicine experience. The daughter that was with her father during his acute stroke, was telling the other family members about the experience: “and so the emergency doctor then got the neurologist, who talked to dad and me, and he told us that dad should get this new medicine which he did, and he could move his arm and leg again before I left the hospital.”  At no point did this daughter mention to her family the qualifier that the neurologist appeared by video. She had already accepted the medium and moved on to what was important to her, that her father get better. Tens of thousands of patients have accepted this new medium, and now the traditional care system is charged with catching up.

Teleneurology has reminded us also that change is hard in clinical medicine but that with telemedicine, great speed can be obtained in capturing the numbers of patient and clinical encounters required to prove the case of this new care delivery tool. Clinical results, financial results, subject populations for clinical trials, all can be accumulated faster with 100 hospitals connected through a single telemedicine system than can be through traditional research collaborations between bricks and mortar providers. In this regard, the growth of telemedicine as a delivery mechanism will be fueled more each month by the accumulation of patient experiences.

To date, of these new and old lessons derived from the experience of teleneurology, many will form the basis for the successful expansion of telemedicine into new clinical venues.  From this regard, teleneurology has, and continues to, plow an important path for the growth of telemedicine. At the same time, teleneurology reminds us of the oldest lesson of change: all the hype over gadgets and the newest and greatest doesn’t overcome the reality that financial considerations drive many changes in healthcare. If financial models are developed that incorporate the same obvious wins for hospitals, patients, neurologists and payors that are intrinsic to the teleneurology model, telemedicine will grow. This lesson from teleneurology is perhaps one of the most important legacies that early teleneurology programs will leave in the unfolding story of telemedicine.

Topics: telemedicine, teleneurology, Physicians, Patients, Efficiency, Uncategorized

Teleneurology as a Model for Telemedicine Growth: Part 1

By Amy Levitt

Emergency teleneurology and telestroke care—the importation of stroke and emergency neurology specialists to the patient’s bedside using videoconferencing technologies—is growing steadily in magnitude, impact and validation. Early in the decade some hundreds of patients each year were connected to specialists by video conferencing; in 2010 literally thousands of acute stroke patients will have a distant specialty neurologist involved in the critical phases of their care. The typical associated conclusion is that the evolution of technology has allowed the growth of telemedicine in general, and specifically teleneurology and telestroke. Nothing could be further from the truth, and it’s time the word gets out that the breakthroughs driving the successful growth of this one dimension of telemedicine are financial, not technical.

Today, both university-based and private telemedicine efforts bring good neurology to the bedside of the patients who most need the benefits of evidence-based best practices. Patient acceptance has proven to be high, technology supportive of good clinical results, and distance-based practice capable of great, measureable clinical impact. Increasingly, local physicians are realizing that telemedicine can be used to enhance, and not burden, their practices, and in the case of on-call coverage, can help them focus upon their core practice and prevent burnout while actually expanding their patient population. The successful evolution of teleneurology is providing an operational model for the effective distribution of other specialty services by telemedicine. And it’s all due to the fact that hospitals who lack effective neurology call coverage are financially worse off, and at a competitive disadvantage to those hospitals that have good call coverage.

The model for hospital-supported teleneurology has been relatively easy to define because about 70% of emergency neurology cases referred to expert neurologists by telemedicine are acute strokes and other neurovascular events. In this narrow collection of diagnoses, it’s been possible to build a reasonable predictive model for hospital returns-on-investment against the costs of imported specialty neurologists. And on that basis, telestroke and teleneurology services have grown, and are demonstrating the values that telemedicine has always seemed to promise but never deliver: efficiency, distribution of talent free of geographic restraints, and real benefits for patients and hospitals.

Not all specialties lend themselves to the financial model that supports teleneurology and telestroke care…But all telemedicine strategies that deliver combined efficiency and quality will eventually find support from a party at-risk for the costs of poor care, and this will spark the attention of telemedicine providers ready to deliver clinical care at a distance. And there will, of course, be technology involved; it will be less expensive than today’s technology; and its reliability will be critical to the effective use of the system, but it will not have started the next push in telemedicine. Finances will drive that. As a model for care, teleneurology has explored interesting ground that will serve as a foundation for other telemedicine specialties. It too has lent some new lessons, and reinforced the importance of some that are old.

Topics: Stroke, teleneurology, Physicians, Patients, neurologists, Efficiency