What Is Telemedicine?

Where does telemedicine in stroke care fit in our healthcare system?

Ross Finesmith MD

There is growing interest in the use remote telemedicine consulting to enhance the clinical medical care in areas with populations that cannot support the demand for such expertise. Neurological disorders lend themselves to the visual benefits of telemedicine.

Telemedicine, or telehealth, is a general term applied to all forms of health information exchange and interaction that utilize advanced technology and communication systems such as the Internet and cellular broadband. This includes long-distance learning and healthcare provision. Telemedicine is not a treatment modality, but rather a subdivision of telehealth methodology used to facilitate healthcare. Cellular broadband transmission has enabled telemedicine   providers to perform medical procedures or examinations and review data remotely including facilitating interactions between patient and provider and multiple providers. Telemedicine can be an especially helpful tool in time-sensitive medical emergencies such as acute ischemic stroke whereby video-conferencing equipment can be used to perform a real-time teleconsultation.

The field of acute stroke care is evolving rapidly which is especially evident in high volume and university hospitals.  Designated stroke centers are staffed by stroke experts in the specialties of neurologists, neuroradiologists and neurosurgeons. Many in urban settings benefit from these technological and academic breakthroughs as this population is within in treatment distance to these stroke centers.  However, most of the population is outside the treatment areas of the centers and are unable to benefit from advanced stroke therapies.

Telemedicine is not a treatment modality but a technology that allows the delivery of previously validated interventions to off-site clinicians.

Teleconsultation has many advantages and uses in clinical care. In the field of stroke, patient outcome data has shown that involvement of a neurologist improves prognosis. A neuro-specialist allows for a more rapid diagnosis of the underlying mechanism of ischemic stroke and leads to more effective and rapid institution of interventions and secondary prevention therapy.

Designated stroke centers have been established across many States and communities in the United States 55. Delivery of advanced therapies, including intravenous tPA is facilitated by specialized stroke and brain imaging expertise. Telestroke videoconferencing consultation can improve access to time-sensitive therapies for patients with acute ischemic stroke and possibly other neurological emergencies.   The use of TR to remotely address urgent patient care needs is promising and has been identified as one of five major priority areas for future development by the Department of Veterans Affairs.