Want To Cut Your Hospital’s Door-To-Needle Time By 13 Minutes?

There are times when 13 minutes can seem like an eternity, like when you’re sitting through movie previews in a theater. But in the world of stroke treatment, shaving 13 minutes off door-to-needle time is more like a heart-pounding Olympic event where every second matters.

Overlook Medical Center and Atlantic Health System in suburban New Jersey recently published a study in the journal, Stroke, which found that patients evaluated for stroke through the use of telehealth while in the ambulance en route to the hospital could be treated with the brain-saving drug alteplase 13 minutes faster than patients who were not evaluated in transit.

“Each passing minute of lost blood supply translates to more brain damage,” said John J. Halperin, lead study investigator and chair of the neurosciences department at Overlook. “Our observations suggest that in-transit telestroke services may provide a scalable, inexpensive way to expedite stroke treatment.”

In New Jersey, in-transit telestroke evaluations require close coordination between Basic Life Support (BLS) ambulances and Advanced Life Support (ALS) units. In Overlook’s service area, four ALS units were equipped with an InTouch Xpress telehealth device, which could be clamped onto BLS ambulance stretchers, allowing images to be transmitted by 4G wireless during patient transport. The stroke neurologist was able to instantly perform an evaluation in collaboration with the attending paramedics.

13 minutes may not sound like much, unless you ask a professional athlete or a stroke patient. For Great Britain’s Mo Farah, 13 well-planned minutes produced a gold medal in the men’s 5000-meter run in Rio. And 15 of the stroke patients in the Overlook/Atlantic study were also winners. They avoided possible death or disability by getting alteplase treatment 13 minutes faster than usual.

Care Coordination, VA-Style

The Department of Veterans Affairs has taken a lot of heat lately, but one thing they’ve done right is to be an early and enthusiastic advocate for telehealth.

Veterans with traumatic brain injuries require care coordination that goes above and beyond. The VA starting using telehealth technology in 2003 to foster greater communication between the veteran’s family members, clinicians and rehab providers.

Here are some lessons we’ve learned from the VA’s head start in telehealth:

  • Be decisive – There’s nothing wishy-washy about the military. Once the VA saw the potential in telehealth, the organization jumped in with gusto. That’s the polar opposite of how Accountable Care Organizations (ACOs) have implemented telehealth. The eHealth Initiative found that just 23 percent of ACOs surveyed were actively using telehealth technology. That’s partly because Medicare’s Pioneer ACO model didn’t initially contain enough telehealth incentives. CMS is trying to remedy that in its soon-to-launch Next Generation ACO model. But so far, ACOs haven’t come roaring out of the telehealth gate like the VA did.
  • Have a vision – When the VA began using telehealth twelve years ago, its stated aim was to “improve the health of designated individuals and populations with the intent of providing the right care in the right place at the right time.”

That last phrase has since become the mantra of telehealth: right care, right place, right time. The VA had a vision for what telehealth could provide – and now it’s a reality around the world.

The VA is the poster child for what it means to be an “early adopter” of telehealth technology for care coordination. Now it’s time for CMS and other influential healthcare organizations to likewise have a dream for what telehealth can accomplish — and to move confidently in that direction.

Veterans Affairs

Telehealth Veterans Affairs





Population Health Requires Telehealth

In recent years, there have been more articles written about population health management than about the entire Kardashian clan.

The first version of population health management had a lot of good intentions but few measurable results. Now comes the hard part: turning mission statements into successful programs. And it’s becoming increasingly obvious that telehealth is an essential ingredient for success.

In a recent article in Executive Insight, Dr. Yulun Wang noted that one of the six pillars in the AHA’s population health roadmap is “seamless care across all settings,” which is practically a Webster’s definition of telehealth. If the population you’re managing happens to be Bear River, Wyoming (population: 521), there are probably not enough locally based primary care physicians, much less specialists, to handle the job. An enterprise telehealth platform is the force multiplier that can solve the problem, while also improving quality and lowering costs.

Dr. Wang’s article also made it clear that many telehealth solutions fall far short of being enterprise platforms, which need to provide:

  •  Scope to accommodate sub-acute services (clinics, SNFs) in addition to high-acuity service lines like ICU, neurology, etc.
  • Scalability to make it easy and cost effective to add new service lines and organizations
  • Ease of use in capturing and viewing clinical data across a wide range of environments and applications
  • High quality and reliability because high-acuity cases often involve life-or-death decisions
  • Access controls to safeguard data integrity across multiple time zones
  • Superior analytics and reporting, both historical and real-time

Any organization that’s serious about population health management must also be willing to implement – or be affiliated with – an enterprise telehealth platform that meets these criteria.


Signaling Telestroke’s Acceptance

It’s rare for the American Heart Association and American Stroke Association to jointly release a new policy statement, so what they said in August garnered a lot of attention.

The organizations unveiled a far-reaching statement entitled “Interactions Within Stroke Systems of Care.” The report examines what a “modern” stroke system should look like – and guides hospitals on how to align resources and develop models of care to improve stroke outcomes.

 This is a landmark document in the telestroke field for a number of reasons. The statement confirms that there’s been a steady seven figure-per-year increase in revenue for the typical outreach telemedicine network. And it also concludes that regionalized telemedicine dramatically improves access to patient care and can be fully self-supporting by creating an effective pathway for transfer of appropriate patients.

The policy statement, co-authored by Randall Higashida, MD and colleagues from the University of California, San Francisco, includes several key recommendations, including:

·         The need to establish protocols to optimize the transfer of stroke patients between hospitals offering different levels of care (or within different departments of a hospital). Telemedicine plays a pivotal role here by streamlining the triage/transfer process.

·         The need to expand telemedicine deployment, particularly in rural areas, to ensure that patients have 24/7 access to expert stroke consultation and care.

The statement also estimates that a “fully functional” stroke system of care that reduces stroke-related deaths by 2% to 3% annually would translate into 20,000 fewer deaths in the U.S. alone and 400,000 worldwide. And you can’t arrive at “fully functional” without a telestroke system solution.

In short, the AHA/ASA statement reveals that the healthcare establishment is very close to accepting telestroke as a standard of care. That’s great news for all of us in the telestroke field, and even better news for the global 400,000 whose lives it can save each year.

The Teleheroes of Sandy

Hoboken, New Jersey, USA – October 31, 2012

After Hurricane Sandy, we heard plenty of stories about heroic first responders from police and fire departments, not to mention the tireless utility crews. But there were plenty of tele-responders, too.

One New Jersey doctor went the extra mile to do a remote presence telestroke consultation – and there’s a man who probably owes him his life.

In the aftermath of Sandy, neurologist Robert Felberg was stuck without power at his Morristown. N.J. home. About the only thing working was his land line, and the call he received was urgent: an elderly patient at Holy Name Medical Center in Teaneck had just suffered a stroke and the ED doctor needed a teleconsultation.

Although Felberg was only 32 miles from the hospital, it might as well have been 3,000. Downed trees and power lines made travel impossible. So Dr. Felberg jumped in his pickup truck and started zig-zagging through neighbors’ yards. He finally found a strong enough 4G signal to do the teleconsultation. Felberg confirmed the on-site physician’s decision to initiate tPA. Within 48 hours, the patient was doing well enough to be discharged.

The InTouch Telemedicine System can be used from virtually any location.

Both Holy Name and Felberg’s own hospital (Overlook Medical Center in Summit, N.J.) never lost power during or after the storm because they planned ahead, making sure there was ample power from generators. “If there’s an award for bravery for prevention, these guys should get it,” he said.

That’s a theme echoed in a paper entitled “Tele-ICU During A Disaster” by Dr. H. Neal Reynolds and colleagues that ran in the Nov. 2011 issue of the journal Telemedicine and e-Health. The paper chronicled how an intensivist was able to stay in close communication with on-site hospitalists and nursing staff following a series of blizzards in Baltimore in 2009-10.

The article concludes that if a health system already has a telemedicine network in place, the organization can simply extend those capabilities to disaster support when needed. But the key is to be prepared. If Holy Name hadn’t established a remote presence network in the first place, Dr. Felberg’s gallant efforts would have fallen short.

As police and firefighters know, bravery will only get you so far. Teleheroes – like all first responders – need to be ready in advance.

To read a full account of the story in the New Jersey Star Ledger, click here.

Crisis In The Stroke Belt

Information provided by the U.S. Centers for Disease Control and Prevention.

We’re all aware that the number of strokes per year in the U.S. is about to cross the 800,000 threshold, but it’s shocking to see how much of that is concentrated in the Southeast region.

Just take a look at this map of the “Stroke Belt” to see how bad it’s gotten in Dixie. It makes you wonder what folks in Phoenix, Minneapolis, and Albany are doing right – and why that success can’t be repeated in the South.

When you take a closer look, you’ll see that many of the nation’s stroke “hot spots” are in underserved areas like northern Maine and in rural parts of the Pacific Northwest. But the South is where you see ample evidence of a double-whammy: a large number of rural communities that don’t have access to advanced stroke care, plus the nation’s highest rates of obesity and high blood pressure.

You’d think that most hospitals in the Southeast would be staffing up on stroke specialists left and right, but many simply can’t afford the high cost of on-site neurointensivists. That’s why telemedicine has such a huge role to play in turning the Stroke Belt into the Southern Success Zone.

Although some sections of the country are more stroke-prone, that doesn’t diminish the need for telestroke capabilities in every community. New Mexico may have enviable stroke statistics, but that doesn’t mean much to someone experiencing a possible stroke in a small town like Portales or Hobbs. Survival trumps statistics every time.

This map makes one thing crystal-clear: hospitals in the South must implement telestroke programs with an urgency akin to D-Day. This year, the number of stroke deaths will be enough to fill two NFL stadiums. That’s totally unacceptable. It’s time to declare war on stroke, with telestroke programs leading the charge.

Strange Bedfellows Indeed

When we recently spoke with the ATA’s CEO Jon Linkous, he said there are plenty of unlikely allies helping to champion telemedicine. On the surface, some of these alliances are head-scratchers. But if you reflect for a moment, you’ll see that telemedicine companies share a common cause with these groups:

NOBEL/Women – No, this isn’t a group of prize winners like Madame Curie. The acronym stands for the National Organization of Black Elected Leaders/Women. They come from the ranks of both state and federal government, and they’re passionate about improving the quality of health care in urban communities. Many people assume that telemedicine mainly benefits rural patients, but many inner-city folks are equally underserved. Many NOBEL women are already sold on the benefits of telemedicine, and they know how to get things done in the halls of power.

Trial lawyers – They’re not the most beloved group inAmerica, but they’re quickly helping to establish telemedicine as a standard of care. In Linkous’ view, attorneys’ efforts may ultimately be more fruitful than trying to get laws passed. Several large hospitals have already had to make large out-of-court settlements because attorneys argued that by not offering telemedicine, the facilities didn’t provide the needed level of care to stroke patients.

Hospitals that do national branding – Linkous notes that highly regarded health systems like The Cleveland Clinic and the Mayo Clinic Care Network are promoting their telemedicine programs in national branding campaigns. When prestigious organizations start practicing and promoting telemedicine nationwide, the rest of the healthcare field takes notice.

If you’re a telemedicine crusader, it’s easy to feel like the Lone Ranger sometimes, but take heart.  You have a host of powerful new allies.  Reach out to them, and be grateful for their help.