More than 45 percent of Americans live more than 60 minutes away from a primary stroke center. And if a stroke has occurred, every minute is precious. The window of opportunity for expert diagnosis and treatment with clot-dissolving therapies or thrombolytics is small, yet those therapies are critical in reducing the risk of permanent disability.
Other emergency care is equally critical. While regional emergency rooms have quality staff in place who can skillfully handle emergency situations, telemedicine allows physicians experienced in trauma and other critical situations to be immediately involved in patient care — as though they were bedside.
Mayo Clinic and Mayo Clinic Health System use telemedicine to bring specialized emergency care — whether for strokes or collapsed lungs — to many rural hospitals.
Mayo Clinic neurologists have been pursuing stroke telemedicine, also known as telestroke, as an innovative way to evaluate acute stroke patients remotely and make treatment recommendations to emergency medicine doctors at other sites.
To conduct stroke telemedicine, Mayo Clinic uses stroke robots with video-screen faces. The Mayo stroke specialist appears on the video screen and speaks directly to patients and attending physicians, just as through they were all in the same room. "This technology allows the Mayo stroke specialist to be anywhere," says Bart Demaerschalk, M.D., Mayo Clinic neurologist and director of the Stroke Telemedicine for Arizona Rural Residents Network.
Through the stroke robot, patients and their health care providers can consult with a team of Mayo neurologists, neurosurgeons, endovascular surgical radiologists and other stroke specialists in real time. The Mayo team and the attending local physicians can also review and share CT scans of the patient's brain — easily and efficiently.
In addition to the stroke robot, Mayo stroke experts can communicate with physicians and patients using digital video cameras, laptops, Internet telecommunications, smart phones and other technology, depending on the remote site's location and available resources.
A recent study of trial stroke telemedicine programs, which included the program at Mayo Clinic in Scottsdale, Ariz., confirmed that compared with telephone-only consultations, telemedicine evaluations resulted in several benefits:
"Results of this trial are significant, in that they confirm the effectiveness of telemedicine as a tool to evaluate acute stroke. This leads to appropriate decisions on behalf of patients — timely treatment, low complication rates and good long-term outcomes," says Dr. Demaerschalk, principal investigator for the Arizona study.
"Telemedicine could be generalized to broader rural settings and communities — among more states, hospitals and providers," says Dr. Demaerschalk.
Mayo Clinic in Arizona currently serves as the stroke telemedicine hub for several remote locations, including Flagstaff, Cottonwood, Kingman, Parket, Yuma and Bisbee, Ariz. Mayo Clinic in Florida and Minnesota already are setting up similar telemedicine programs.
Physicians anywhere in the world can access the expertise of Mayo Clinic stroke experts using an Internet-based tool called Global Stroke, through which Mayo neurologists share second opinions within 72 hours.
Mayo's innovative stroke robot technology is not intended to replace true face-to-face communication, but rather is a way to enhance it for patients in rural areas or physicians looking to collaborate worldwide.
Telemedicine is not just for strokes. For patients like Bill Price, who live in a rural area, the axiom "a picture is worth a thousand words" has new meaning.
After a weekend of breathing difficulties, Bill, 70, was diagnosed with a collapsed lung and sent to the emergency department in Barron, Wis. There, John Graykoski, a physician assistant, used telemedicine to connect directly to Alex Beuning, M.D., regional medical director of emergency services at Mayo Clinic Health System in Eau Claire, Wis.
"We needed to get a tube into the chest to remove the air that had caused the lung to collapse," John says. "The physicians in Eau Claire guided the video camera, so they could see exactly what they wanted."
Bill Price says he had instant relief from breathing.
The video conferencing unit used to help Bill Price is also available at the Mayo Clinic Health System in Bloomer, Wis. It offers a zoom feature for close-up views and a view screen so patients are able to see and speak with the physician providing care from miles away.
In every case, the signals sent using telemedicine are encrypted so transmissions are secure and private in compliance with Health Insurance Portability and Accountability Act privacy regulations.
"While the regional emergency rooms have quality staff that skillfully handle emergency situations, the benefit of telemedicine is that physicians experienced in trauma and other critical situations are immediately involved in the care of patients," says John Graykoski, physician assistant.
"Telemedicine is a way to spread specialty care to rural areas," says Dr. Beuning. Telemedicine also offers another important benefit: peace of mind to patients living in outlying communities.