Friday, June 5, 2015

Testifying in support of TeleStroke

STRONG SUPPORT: Schwamm testifies via videoconference

In the U.S., someone has a stroke every 40 seconds. Previously there were great barriers to fast treatment and a lack of access to experts; however, the introduction of TeleStroke now enables doctors to diagnose stroke patients located anywhere within minutes, at any time of day, through video, smartphones and other technology. This significantly cuts down on the time between the symptom onset and the moment a patient receives tissue plasminogen activator (tPA), a clot-busting drug that can greatly improve recovery outcomes.

As the momentum of TeleStroke grows, MGH doctors also are supporting ways to expand this treatment to more patients. On May 20, Lee Schwamm, MD, executive vice chairman of the Department of Neurology and director of Stroke Services and the Partners TeleStroke Network, joined a team of experts to testify via videoconference before the U.S. Senate in support of the Furthering Access to Stroke Telemedicine (FAST) Act, introduced by Sen. Mark Kirk (R-Illinois). As Medicare currently only reimburses TeleStroke diagnoses and treatments for patients located in rural settings, the bill would expand coverage to every potential TeleStroke patient.

“Being able to lay your eyes on a patient and examine the nervous system is a vital part of making this diagnosis correctly,” said Schwamm during his testimony. “This is a very time-dependent treatment, and we have to get people treated as quickly as possible. Since we can’t bring every patient to a comprehensive stroke center, we’ve got to figure out how to bring the doctor to the patient, and that is really what TeleStroke is about.”

Schwamm said TeleStroke is used when a patient transferred to a regional community hospital with stroke symptoms. The on-call teleneurologist located at a comprehensive stroke care center or larger hospital – such as the MGH – is paged for a consultation, receives and reviews the patient’s brain scans through a secure online portal, and returns the page by phone. Depending on the nature of the case, the call may transition to a videoconference. If appropriate, the specialist will conduct a neurological assessment of the patient with the local emergency department physician. The specialist will then document their findings within a TeleNeurology portal and collaborate with the local physicians and the neurologist on the best approach to care.

In 2014, the MGH had a total of 1,202 TeleStroke cases with 542 video consults and 660 phone consults. Out of those cases, 65 percent of patients remained at their community hospitals.

“These are some tough economic times for many hospitals,” said Juan Estrada, director of MGH’s TeleNeurology Program. “Lack of reimbursement is a major barrier to the development of TeleStroke programs. Our experience at the MGH shows there is tremendous value to the American health care system in the development of TeleStroke networks. We are confident that the proposed reimbursement will increase the rate at which the thousands of hospitals that currently lack around-the-clock stroke coverage adopt TeleStroke as the affordable, effective solution to the problem.”





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