Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association.

In 2005, the American Stroke Association formed a task force on the development of stroke systems to propose a new framework for stroke care delivery that would emphasize linkages rather than silos in the chain of stroke survival and provide a blueprint for large organizations or state and federal agencies on how to implement a more coordinated approach to stroke care.1 The stroke systems of care model (SSCM) recommends implementation of telemedicine and aeromedical transport to increase access to acute stroke care in neurologically underserved areas, as do the latest American Stroke Association guidelines for the early management of adults with ischemic stroke.2 The present report was commissioned by the American Heart Association to address how telemedicine might help address current barriers to improved stroke care delivery in the United States within the framework of the SSCM. Telemedicine has been defined broadly as “the use of telecommunications technologies to provide medical information and services” (p 483).3 Technically, this encompasses all aspects of medicine practiced at a distance, including use of telephone, fax, and electronic mail technology, as well as the use of interactive full-motion integrated video and audio, that brings together patients and providers separated by distance.4 In the early part of the twentieth century, electrocardiograms and electroencephalograms were transmitted over ordinary analogue telephone lines, and in 1920, medical advice service for sea craft via Morse code and voice radio was established. Expensive and cumbersome 2-way closed-circuit television systems used in the 1960s to transmit radiographs and evaluate patients have been replaced by low-cost, personal computer–based solutions for videoconferencing and transmission of physiological data from clinics or patient homes or from inaccessible sites such as ships, aircraft, and geographically remote regions.5 Telemedicine has been proposed as an alternative means of managing many different diseases and …

[1]  J. Alvir,et al.  Conditions that mimic stroke in the emergency department. Implications for acute stroke trials. , 1995, Archives of neurology.

[2]  A. Allen,et al.  Telemedicine technology and clinical applications. , 1995, JAMA.

[3]  R. Kovner,et al.  Telemedicine: potential applications and barriers to continued expansion. , 1996, Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners.

[4]  S. Yeh,et al.  Outcomes of stroke patients in Medicare fee for service and managed care. , 1998, JAMA.

[5]  J. Slattery,et al.  How do stroke units improve patient outcomes? A collaborative systematic review of the randomized trials. Stroke Unit Trialists Collaboration. , 1997, Stroke.

[6]  J H Sanders,et al.  Telemedicine: Where It Is and Where It's Going , 1998, Annals of Internal Medicine.

[7]  M Frankel,et al.  Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke , 1998, Neurology.

[8]  W. Rosamond,et al.  Time delays in accessing stroke care in the emergency department. , 1999, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[9]  J. Kvedar,et al.  Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale. , 1999, Stroke.

[10]  S. Levine,et al.  "Telestroke" : the application of telemedicine for stroke. , 1999, Stroke.

[11]  David L. Paul,et al.  Assessing technological barriers to telemedicine: technology-management implications , 1999 .

[12]  Guyer.  The mind sees more than the movie frame , 2000, The Western journal of medicine.

[13]  H L Daly,et al.  Telemedicine: the invisible legal barriers to the health care of the future. , 2000, Annals of health law.

[14]  P. Langhorne,et al.  Organized Inpatient (Stroke Unit) Care for Stroke , 2008 .

[15]  A. Kramer,et al.  Outcome and Utilization Differences for Older Persons with Stroke in HMO and Fee‐for‐Service Systems , 2000, Journal of the American Geriatrics Society.

[16]  T. Nesbitt,et al.  Development of a telemedicine program: a review of 1,000 videoconferencing consultations. , 2000, The Western journal of medicine.

[17]  A. Furlan,et al.  Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. , 2000, JAMA.

[18]  Richard Wootton,et al.  The point-of-referral barrier—a factor in the success of telehealth , 2001, Journal of telemedicine and telecare.

[19]  L Karlsson,et al.  The Potential of Telemedicine: Barriers, Incentives and Possibilities in the Implementation Phase , 2001, Journal of telemedicine and telecare.

[20]  Thompson G. Robinson,et al.  National Clinical Guidelines for Stroke. , 2001 .

[21]  Rod R Zalunardo,et al.  Barriers to telemedicine implementation. Usually it's not technology issues that undermine a project--it's everything else. , 2002, Healthcare informatics : the business magazine for information and communication systems.

[22]  P. Langhorne,et al.  Organized Inpatient (Stroke Unit) Care for Stroke , 2014, The Cochrane database of systematic reviews.

[23]  D. Kobal,et al.  Background , 2003 .

[24]  Gary A. Ford,et al.  Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test , 2003, Stroke.

[25]  P. Hu,et al.  Telemedicine for Acute Stroke: Triumphs and Pitfalls , 2003, Stroke.

[26]  M. Hammer,et al.  Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: A Cleveland Update , 2003, Stroke.

[27]  David C. Hess,et al.  Remote Evaluation of Acute Ischemic Stroke: Reliability of National Institutes of Health Stroke Scale via Telestroke , 2003, Stroke.

[28]  Mateusz Scibor,et al.  Telemedicine in Emergency Evaluation of Acute Stroke: Interrater Agreement in Remote Video Examination With a Novel Multimedia System , 2003, Stroke.

[29]  N. Antoniotti,et al.  The technology-privacy conundrum. HIPAA perspectives for telehome care providers. , 2003, Caring : National Association for Home Care magazine.

[30]  B. Widder,et al.  Teleneurology to Improve Stroke Care in Rural Areas: The Telemedicine in Stroke in Swabia (TESS) Project , 2003, Stroke.

[31]  Yan Xiao,et al.  Shortening time to stroke treatment using ambulance telemedicine: TeleBAT. , 2004, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[32]  P. Heuschmann,et al.  Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy , 2004 .

[33]  G. Birbeck,et al.  VA Stroke Study: Neurologist care is associated with increased testing but improved outcomes , 2004, Neurology.

[34]  P. Heuschmann,et al.  Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy. , 2004, JAMA.

[35]  G. Duckwiler,et al.  Access to intra-arterial therapies for acute ischemic stroke: an analysis of the US population. , 2004, AJNR. American journal of neuroradiology.

[36]  Robert J Adams,et al.  Remote Evaluation of Acute Ischemic Stroke in Rural Community Hospitals in Georgia , 2004, Stroke.

[37]  Scott Hamilton,et al.  Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials , 2004, The Lancet.

[38]  Elif Derya Übeyli,et al.  Theory and Applications of Telemedicine , 2002, Journal of Medical Systems.

[39]  Joseph P Broderick,et al.  Eligibility for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke: A Population-Based Study , 2004, Stroke.

[40]  Iva Petkovska,et al.  Virtual TeleStroke support for the emergency department evaluation of acute stroke. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[41]  Markus Horn,et al.  Telemedicine for Safe and Extended Use of Thrombolysis in Stroke: The Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria , 2005, Stroke.

[42]  Robert J Adams,et al.  REACH: Clinical Feasibility of a Rural Telestroke Network , 2005, Stroke.

[43]  P. Whitten,et al.  Addressing telehealth's foremost barrier: Provider as initial gatekeeper , 2005, International Journal of Technology Assessment in Health Care.

[44]  U. Bogdahn,et al.  The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities , 2005, Neurocritical care.

[45]  L. Lisabeth,et al.  Survey of emergency physicians about recombinant tissue plasminogen activator for acute ischemic stroke. , 2005, Annals of emergency medicine.

[46]  Peter Moyer,et al.  Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association’s Task Force on the Development of Stroke Systems , 2005, Circulation.

[47]  R. Raman,et al.  Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System , 2005, Neurology.

[48]  Marc Fisher,et al.  Developing and implementing future stroke therapies: The potential of telemedicine , 2005, Annals of neurology.

[49]  U. Bogdahn,et al.  Can Telemedicine Contribute to Fulfill WHO Helsingborg Declaration of Specialized Stroke Care? , 2005, Cerebrovascular Diseases.

[50]  B. Demaerschalk,et al.  Economic Benefit of Increasing Utilization of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in the United States , 2005, Stroke.

[51]  V. Preedy,et al.  Scottish Intercollegiate Guidelines Network , 2010 .

[52]  B. Norrving,et al.  Helsingborg Declaration 2006 on European Stroke Strategies , 2006, Cerebrovascular Diseases.

[53]  P. Heuschmann,et al.  Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany , 2006, The Lancet Neurology.

[54]  J. Grotta,et al.  Using telemedicine to facilitate thrombolytic therapy for patients with acute stroke. , 2006, Joint Commission journal on quality and patient safety.

[55]  E. Dooley.  National Institute of Neurological Disorders and Stroke , 2006 .

[56]  Robert J Adams,et al.  Telestroke: extending stroke expertise into underserved areas , 2006, The Lancet Neurology.

[57]  Michael I Weintraub,et al.  Thrombolysis (Tissue Plasminogen Activator) in Stroke: A Medicolegal Quagmire , 2006, Stroke.

[58]  Pamela Whitten,et al.  Evolution of telemedicine from an applied communication perspective in the United States. , 2006, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[59]  R. Silbergleit,et al.  Economic benefit of increasing utilization of intravenous tissue plasminogen activator for acute ischemic stroke in the United States. , 2005, Stroke.

[60]  B. Murray,et al.  Telestroke: a multi-site, emergency-based telemedicine service in Ontario. , 2006, Journal of telemedicine and telecare.

[61]  P. Whitten,et al.  Perspectives from the Veterans Health Administration about opportunities and barriers in telemedicine , 2006, Journal of telemedicine and telecare.

[62]  Christian Kukla,et al.  Comparison of Tissue Plasminogen Activator Administration Management Between Telestroke Network Hospitals and Academic Stroke Centers: The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany , 2006, Stroke.

[63]  NIH-Stroke Scale , 2006 .

[64]  D. Leys,et al.  The Main Components of Stroke Unit Care: Results of a European Expert Survey , 2007, Cerebrovascular Diseases.

[65]  Adnan I. Qureshi,et al.  Guidelines for the Early Management of Adults With Ischemic Stroke , 2007 .

[66]  P. Amarenco,et al.  Telemedicine for Improving Emergent Management of Acute Cerebrovascular Syndromes , 2007, International journal of stroke : official journal of the International Stroke Society.

[67]  Prehospital and hospital delays after stroke onset--United States, 2005-2006. , 2007, MMWR. Morbidity and mortality weekly report.

[68]  R. Józefowicz.  Neurology residency training in the US and Poland , 2007, Nature Clinical Practice Neurology.

[69]  P. Gorelick,et al.  Alaska Native Stroke Registry , 2007, International journal of stroke : official journal of the International Stroke Society.

[70]  R. Merrell,et al.  Telemedicine licensure in the United States: the need for a cooperative regional approach. , 2007, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[71]  U. Bogdahn,et al.  Long-term outcome after thrombolysis in telemedical stroke care , 2007, Neurology.

[72]  F. Shamsa,et al.  High Blood Pressure Trends in Children and Adolescents in National Surveys, 1963 to 2002 , 2007, Circulation.

[73]  H. Diener,et al.  Association Between Disability Measures and Healthcare Costs After Initial Treatment for Acute Stroke , 2007, Stroke.

[74]  Pamela Whitten,et al.  Private payer reimbursement for telemedicine services in the United States. , 2007, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[75]  Prevalence of actions to control high blood pressure--20 states, 2005. , 2007, MMWR. Morbidity and mortality weekly report.

[76]  D. Leys,et al.  Facilities Available in European Hospitals Treating Stroke Patients , 2007, Stroke.

[77]  Prevalence of self-reported cardiovascular disease among persons aged > or =35 years with diabetes--United States, 1997-2005. , 2007, MMWR. Morbidity and mortality weekly report.

[78]  S. Nakaaki,et al.  Greater Impairment of Ability in the Divided Attention Task Is Seen in Alzheimer’s Disease Patients with Depression than in Those without Depression , 2007, Dementia and Geriatric Cognitive Disorders.

[79]  B. Demaerschalk,et al.  How Diagnosis-Related Group 559 Will Change the US Medicare Cost Reimbursement Ratio for Stroke Centers , 2007, Stroke.

[80]  R. Raman,et al.  The STRokE DOC Trial Technique: ‘Video Clip, Drip, and/or Ship’ , 2007, International journal of stroke : official journal of the International Stroke Society.

[81]  D. Williamson,et al.  The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976-2004. , 2007, Preventive medicine.

[82]  Tom H. F. Broens,et al.  Determinants of successful telemedicine implementations: a literature study , 2007, Journal of telemedicine and telecare.

[83]  P. Touboul,et al.  A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects , 2007, The Lancet Neurology.

[84]  Soojin Park,et al.  Organizing regional stroke systems of care , 2008, Current opinion in neurology.

[85]  Ronald G. Thomas,et al.  Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study , 2008, The Lancet Neurology.

[86]  H. Audebert,et al.  Telemedically Provided Stroke Expertise beyond Normal Working Hours , 2008, Cerebrovascular Diseases.

[87]  B. Liang,et al.  Empirical characteristics of litigation involving tissue plasminogen activator and ischemic stroke. , 2008, Annals of emergency medicine.

[88]  K. Furie,et al.  Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2007, Circulation.

[89]  Robert J Adams,et al.  A web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments. , 2009, The Journal of emergency medicine.

[90]  Lynn A. Karoly,et al.  Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification , 2010, Practice Management Consultant.

[91]  Lorraine Smith,et al.  Management of Patients With Stroke: Rehabilitation, Prevention and Management of Complications, and Discharge Planning: a National Clinical Guideline , 2010 .