Obstacles and Solutions in the Implementation of Telestroke

Aita, Mark C.; Nguyen, Kim Cuc Thi; Bacon, Robert; Capuzzi, Kevin M.

doi:10.1161/strokeaha.113.001889

Cited by 14 publications

(13 citation statements)

References 15 publications

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“…Telestroke can bring stroke expertise to underserved geographical areas [10,42,43,44] and may help solve the shortage of stroke experts [45,46,47] by allowing remote assessment of stroke patients via audio-video conference and by assisting local physicians in the decision-making process for acute stroke [41]. Pursuant to ongoing technological developments and in line with the ASA and the ESO guidelines, the implementation of telestroke for optimizing in-hospital stroke care is currently applied in several countries [48,49,50,51,52,53,54].…”

Section: New Developments and Future Conceptsmentioning

confidence: 99%

See 1 more Smart Citation

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

et al. 2014

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Background: The global burden of stroke is immense, both in medical and economic terms. With the aging population and the ongoing industrialization of the third world, stroke prevalence is expected to increase and will have a major effect on national health expenditures. Currently, the medical treatment for acute ischemic stroke is limited to intravenous recombinant tissue plasminogen activator (IV r-tPA), but its time dependency leads to low utilization rates in routine clinical practice. Prehospital delay contributes significantly to delayed or missed treatment opportunities in acute stroke. State-of-the-art acute stroke care, starting in the prehospital phase, could thereby reduce the disease burden and its enormous financial costs. Summary: The first part of this review focuses on current education measures for the general public, the emergency medical services (EMS) dispatchers and paramedics. Although much has been expected of these measures to improve stroke care, no major effects on prehospital delay or missed treatment opportunities have been demonstrated over the years. Most interventional studies showed little or no effect on the onset-to-door time, IV r-tPA utilization rates or outcome, except for prenotification of the receiving hospital by the EMS. No data are currently available on the cost-effectiveness of these commonly used measures. In the second part, we discuss new developments for the improvement of prehospital stroke diagnosis and treatment which could open new perspectives in the nearby future. These include the implementation of prehospital telestroke and the deployment of mobile stroke units. These approaches may improve patient care and could serve as a platform for prehospital clinical trials. Other opportunities include the implementation of noninvasive diagnostics (like transcranial ultrasound and blood-borne biomarkers) and the reevaluation of neuroprotective strategies in the prehospital phase. Key Messages: Timely initiation of treatment can effectively reduce the medical and economic burden of stroke and should begin with optimal prehospital stroke care. For this, prehospital telemedicine is a particularly attractive approach because it is a scalable solution that has the potential to rapidly optimize acute stroke care at limited cost.

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Section: New Developments and Future Conceptsmentioning

confidence: 99%

“…To allow breakthrough results, several issues still need to be tackled, including data security, privacy, medical device regulations, liability on product failure and reimbursement [44,73]. …”

Section: New Developments and Future Conceptsmentioning

confidence: 99%

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

et al. 2014

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“…The most important hurdle is third party reimbursement. It took decades for the concept of telemedicine to come to fruition, and pay parity kept telemedicine programs across the country from flourishing, sustaining, and expanding [121][122][123][124][125][126]. Without appropriate reimbursement, the burden of financial overhead in maintaining the high-quality video interface, teleneurology and teleradiology coverage, and costs of emergent care including imaging, tPA, and transportation to hub hospitals would make telestroke network unsustainable.…”

Section: Issues Regarding Reimbursementmentioning

confidence: 99%

“…Without appropriate reimbursement, the burden of financial overhead in maintaining the high-quality video interface, teleneurology and teleradiology coverage, and costs of emergent care including imaging, tPA, and transportation to hub hospitals would make telestroke network unsustainable. The Centers for Medicare and Medicaid Services (CMS) has addressed the need for reimbursement for telemedicine services and third-party payers have followed suit [37,121]. Appropriate reimbursement for teleservices remains a concern among providers [127] and continues to be a barrier for the expansion of telestroke networks to underserved areas of the country.…”

Section: Issues Regarding Reimbursementmentioning

confidence: 99%

Telestroke: A New Paradigm

Sharma¹,

Nalleballe²,

Kapoor³

et al. 2021

Ischemic Stroke

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Stroke is one of the leading causes of death and disability across the world. With the development of new modalities of treatment, including the use of intravenous tissue plasminogen activator and mechanical thrombectomy, clinical outcomes have improved in patients with acute ischemic strokes. However, these interventions are time dependent, and there exists a great disparity between the rural and urban parts of the world in terms of the availability of neurologists and these lifesaving treatment options. Telestroke networks utilize digital technology for two-way, highresolution video teleconferencing to help abate these disparities by bringing safe, efficient, and cost-effective care to underserved communities in the United States and around the world.

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“…Similarly, even when services are reimbursed, the current range of billing codes does not reflect the services offered. Many payers recognize billing codes for initial evaluation and management, but do not differentiate between a consultation and ongoing remote management of critically ill patients 32. Critical care billing codes specifically require that the treating physician be in close physical proximity to the patient (usually on the same physical unit of the hospital) and are silent as to their use in telemedicine encounters, and therefore inappropriate as written to support telemedicine.…”

Section: Expanding Access To Telestrokementioning

confidence: 99%

Telestroke—the promise and the challenge. Part two—expansion and horizons

Akbik

Hirsch

Chandra

et al. 2016

J NeuroIntervent Surg

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Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care. This is the second of a two part review, and is focused on the challenges telestroke faces for wider adoption. It further details the anticipated evolution of this novel therapeutic platform, and the potential roles it holds in stroke prevention, ambulance based care, rehabilitation, and research.

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Obstacles and Solutions in the Implementation of Telestroke

Cited by 14 publications

References 15 publications

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

Telestroke: A New Paradigm

Telestroke—the promise and the challenge. Part two—expansion and horizons

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