Stroke telemedicine launched in the Midwest

Mayo Clinic has been a leader in the field of stroke telemedicine, which uses audiovisual technology to connect patients in rural areas with stroke specialists at hub hospitals. Starting at Mayo Clinic in Phoenix, Ariz., stroke telemedicine subsequently expanded to Mayo's campus in Jacksonville, Fla. Now, Mayo Clinic in Rochester, Minn., is a stroke telemedicine hub serving 18 hospitals in the Mayo Clinic Health System in Minnesota and Wisconsin.

"We're expanding the Mayo Clinic Model of Care for stroke telemedicine to the Upper Midwest. The goal is to bring Mayo Clinic stroke expertise to each of the sites in our health system, through collaboration with physicians and other providers at those sites, and then expand later this year to non-Mayo sites as well," says Robert D. Brown Jr., M.D., a neurologist at Mayo in Minnesota.

Like the Mayo campuses in Arizona and Florida, the Minnesota site has a stroke subspecialty neurologist available round-the-clock for consultation with emergency room providers in network hospitals. The stroke specialist conducts patient evaluations remotely, using technology brought to the patient's bedside. CT scans can be uploaded and immediately reviewed by the stroke specialist in Rochester, and therapeutic options discussed with the treatment team at the network hospital.

"The system provides a high-quality audiovisual connection with the ability to focus the camera on the patient, zoom in and out, tilt up and down, and pan from side to side. We can both review the imaging and share the image back again with the team at the bedside, pointing out any key findings for the patient, the family or the providers," Dr. Brown says.

Stroke telemedicine increases the likelihood that patients who need clot-dissolving or other advanced therapies receive them quickly, thereby lessening the risk of significant deficit after stroke. "If intra-arterial therapies are required, patients can be immediately airlifted to Rochester, where emergency diagnostic cerebral angiogram and endovascular therapy capabilities are available 24/7 for advanced intervention," Dr. Brown notes. Patients may also be transferred to Mayo Clinic Health System hospitals in La Crosse or Eau Claire, Wis., or Mankato, Minn.

Expansion beyond Mayo Clinic Health System

The goal over time is to extend stroke telemedicine to hospitals outside Mayo Clinic Health System. That effort will draw on Mayo's experience in Arizona and Florida, where network hospitals typically aren't part of Mayo Clinic Health System, but some are affiliated in other ways, such as through the Mayo Clinic Care Network. "We're basing our model on the very advanced and mature program that exists at Mayo Clinic in Arizona and in Florida. Our colleagues there are assisting us because this is an enterprisewide effort to cover stroke telemedicine very broadly," Dr. Brown says.

Telemedicine at Mayo in Minnesota will also be extended eventually to other neurological conditions, such as epilepsy, neurological emergencies other than stroke, and sports concussion, as it has been at Mayo in Arizona. "Connecting with patients and referring physicians is critical to Mayo Clinic's strategic direction as we deliver knowledge, expand reach and transform health care," says Bart M. Demaerschalk, M.D., a neurologist at Mayo in Arizona and the founder of the Mayo Clinic telestroke network there.

"Telestroke is the most mature of any telemedicine service line in the clinical neurologic sciences and is supported by a strong body of evidence demonstrating its reliability, validity, safety, efficacy, and clinical and cost-effectiveness compared with face-to-face stroke care," says Dr. Demaerschalk. "While a real stroke team at the bedside is desirable, a virtual stroke team can approximate the real thing and is quickly becoming the standard of care in every acute care environment lacking emergency stroke services."

Feb. 28, 2014