Allison Gandey

May 05, 2011

May 5, 2011 — A virtual emergency support system has improved tissue plasminogen activator use in Arkansas from less than 1% to 30%, researchers are reporting. The telestroke intervention has also sped up door-to-needle times by 10 minutes.

Arkansas has one of the highest stroke mortality rates in the United States. Using real-time, interactive video, the new program links urban neurologists with stroke patients in remote areas. The intervention, known as Arkansas' stroke assistance through virtual emergency support or Arkansas SAVES, has already provided more than 300 consults and is helping rural emergency departments diagnose conditions and improve patient outcomes.

"With this virtual environment, rural patients can seek the level of care afforded to patients at urban medical centers," explained the investigators led by Julie Hall-Barrow, EdD, from the University of Arkansas in Little Rock. They presented the new approach Tuesday in Tampa, Florida, at the American Telemedicine Association 16th Annual International Meeting.

Speaking to reporters at a news conference, hospital administrator Sandra Bowden gave a first-hand account of how virtual environments works. Bowden started out building programs similar to Arkansas SAVES but wound up the recipient of care when she had a sudden stroke.

Experts say the next generation of remote patient monitoring systems will be mobile phone based.

"It saved my life," said Bowden, based at the Christus St. Michael Health System in Texarkana, Texas. Bowden admitted that she had been somewhat skeptical about the long-distance approach but was converted by the personal care she received by Todd Samuels, MD, neurologist on call.

"He spoke with me, my husband, and other care providers, and it was like he was right there in the room with us," she said. Her gratitude was evident as she warmly welcomed her physician to the podium to speak next.

Dr. Samuels acknowledged that Bowden is doing very well. "It's very rewarding," he said, visibly moved.

Dr. Samuels said that he too had wondered at the outset whether long-distance appointments would work. "But with the flip of a button, I find I can be right there at the patient's bedside."

It saved my life.

Dr. Samuels explained he has tech professionals who work on call to make sure the technology is functioning well and remains in the background of care. "This levels the playing field across the nation — whether you are in New York City, Montana, or West Texas — all patients receive the same care."

The program currently operates with 3 neurology hubs and 20 emergency locations. With funding from the Arkansas Department of Human Services Medical Division, plans are under way to increase this to 4 specialist hubs and 27 rural locations by June.

The program includes a monthly all-sites meeting where providers participate in an interactive video case review. Staff at each site also participates in telemedicine drills using a competency-based checklist.

Improving Care

Dale Alverson, MD, president of the American Telemedicine Association, said that programs like this improve care. "People often ask, 'How can we afford this in an economic downturn?' I believe this will save our healthcare system money. It will improve health and reduce costs."

In a separate presentation at the meeting, Joseph Cafazzo, PhD, senior director of eHealth Innovation at the University Health Network of Toronto, Ontario, Canada, released preliminary findings from the first clinical trial of an iPhone application with a fully integrated glucometer. The results show the remote monitoring system is helping adolescents with diabetes control their blood sugar.

"We are very encouraged that the next generation of remote patient monitoring systems will be mobile phone based," Dr. Cafazzo told reporters. "We need to address huge numbers of people with chronic conditions in the millions and the tens of millions, and many of the current technologies can only deal with the hundreds of thousands."

He explained that teenagers were targeted for the study because the transition from childhood to adolescence is especially challenging for maintaining good glycemic control and their attention span is short. To make participation more enticing, the researchers included a microblogging chat room and a redeemable point system that rewarded participants with iTunes for taking and reporting their blood sugar levels.

Dr. Cafazzo also shared findings from completed studies that showed a mobile based–phone system significantly improved uncontrolled blood pressure in patients with diabetes and chronic heart failure.

The telestroke intervention is funded by the Arkansas Department of Human Services Medical Division. The researchers have disclosed no relevant financial relationships.

American Telemedicine Association (ATA) 16th Annual International Meeting: Abstract 486. Presented May 3, 2011.

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