According to new scientific evidence, a remote exam of a stroke patient performed via videoconferencing is as effective as a bedside evaluation, and a good argument for the increased use of telemedicine for stroke care.
A recent article in Stroke: Journal of the American Heart Association says high-quality videoconferencing not only increases access to stroke patients in rural areas but could also allow physicians to treat a transient ischemic attack (TIA) with the same urgency and abilities as a full-blown stroke.
Patients suffering from TIA must quickly be evaluated to determine if they're eligible for time-sensitive treatment such as tissue plasminogen activator (tPA), which can save brain function and reduce disability. Stroke and brain imaging specialists are often required to perform the evaluation.
"We think a TIA should be treated as an emergency, just like a major stroke," said J. Donald Easton, MD, writing chair of the statment and professor and chairman of the Department of Clinical Neurosciences at Alpert Medical School of Brown University and the Rhode Island Hospital in Providence, R.I. "Because we know the high risk of a future stroke, this is a golden opportunity to prevent a catastrophic event."
There are only an average of four neurologists per 100,000 people in the United States, and not all of them specialize in stroke. Telemedicine, or telestroke, coupled with teleradiology, could broaden the reach of neurologists and allows for the remote reviewing of brain images.
"Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance," said Lee Schwamm, MD, lead author of the scientific statement and policy statement on telemedicine, associate professor of neurology at Harvard Medical School and vice chairman of neurology at Massachusetts General Hospital.
In order for telemedicine to be used effectively in treating stroke patients, Schwamm says changes are needed in how telemedicine activities are reimbursed. Policy recommendations include:
- Deploying telestroke systems to supplement resources where around-the-clock, local, on-site acute stroke expertise is insufficient.
- Increasing Medicare reimbursement for telestroke assessment, diagnosis and approval to use tPA to reflect the increased upfront costs of implementation.
- Developing a mechanism for uniform, streamlined credentialing for telestroke providers and uniform national telemedicine licensure by state medical boards.
- Increasing funding sources for stroke telemedicine programs which could include designating support from the federal American Recovery and Reinvestment Act of 2009.