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BRIEF COMMUNICATIONS: B. C. Meyer, P. D. Lyden, L. Al-Khoury, Y. Cheng, R. Raman, R. Fellman, J. Beer, R. Rao, and J. A. Zivin Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System Neurology 2005; 64: 1058-1060 [Abstract] [Full text] [PDF]

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Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System

Hartmut Gross, C.E. Hall, S. Wang, C. Pardue, D.C. Hess, F.T. Nichols, R.J. Adams   (4 August 2005)

Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System 4 August 2005
Hartmut Gross, Medical College of Georgia 1120 15th Street, Augusta, GA 30912, C.E. Hall, S. Wang, C. Pardue, D.C. Hess, F.T. Nichols, R.J. Adams Send Correspondence to journal: Re: Prospective reliability of the STRokE DOC Wireless/Site Independent Telemedicine System hgross{at}mail.mcg.edu Hartmut Gross, et al.	The San Diego wireless telemedicine stroke evaluation arrangement described by Meyer et al is unusual. [1] Our similar REACH (Remote Evaluation of Acute isCHemic stroke) system at the Medical College of Georgia (MCG) uses secure Internet connections to evaluate acute stroke patients in rural hospitals of north central Georgia in the Nation’s “stroke belt.” Like the San Diego system, REACH uses any broadband (DSL or cable modem) Internet accessible computer, nationwide. However, without a broadband wireless bubble over Augusta, Georgia, consulting physicians still need access to a fixed desktop or wireless Internet connection. Our validation of the remote reliability in 2002 of the NIH stroke score via the REACH system also showed no greater than three points difference between bedside and remote evaluators. [2] REACH has currently expanded live 24/7/365 coverage to eight rural hospitals within a 90-mile radius of Augusta. The rural sites with broadband Internet access have a wireless router, mobile wireless cart with a PC, a remotely driven camera, and battery backup installed in the Emergency Department (ED). The rural hospitals have 24/7 CT scan capability with DICOM compatibility, as our system also integrates sending a one way video stream and the patient’s CT scan which the REACH consultant interprets. A validating standard verifies that the CT scan can be reliably read from any desktop. Technical specifications of the system have been reported. [2-4] In the three-year expansion of REACH more than 200 consultations have been performed with 31 patients receiving tPA, of which 18 received thrombolysis in under 2 hours. To date, there have been no hemorrhagic complications. Despite sporadic technical problems it has been possible to complete every consult. We concur that provision of neurology expertise via a live Internet consultation can greatly improve acute stroke care. Given connectivity to a certified stroke center, the smallest rural hospitals would effectively meet BAC criteria as stroke centers. [5] Hub and Spoke Networks would exponentially speed the realization of a nationwide net of primary and comprehensive stroke centers such that no stroke patient is beyond reach. Unfortunately, barriers include slow-to-change reimbursement policies, state licensing, and individual hospital privileging policies which lag behind. With these types of networked rural sites, it will become easier to implement safer treatment modalities and facilitate early treatment of patients with hemorrhagic strokes, once effective agents are approved. References 1. Meyer BC, Lyden PD, Al-Khoury L et al. Prospective Reliability of the STRokE DOC Wireless/Site Independent Telemedicine System. Neurology 2005; 64: 1058-1060. 2. Wang S, Lee SB, Pardue C, et al. Remote Evaluation of Acute Ischemic Stroke - Reliability of National Institutes of Health Stroke Scale via Telestroke. Stroke 2003; 23: e188-e191. 3. Wang S, Gross H, Lee SB, et al. Remote Evaluation of Acute Ischemic Stroke in Rural Community Hospitals in Georgia. Stroke 2004;36:1763-1768. 4. Pearl HK, Wang S, Gross H, et al. Telemedicine and Healthcare-A Rural Resident's Access to Stroke Treatment. The e-Journal of the South Carolina Medical Association 2005; 101: 3e-7e. 5. Alberts MJ, Hademenos G, Latchaw RE, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA 2000;283: 3102-3109. The authors had the opportunity to respond to this Correspondence but declined.