St. John Providence is proposing a comanagement structure in telestroke to help guide the program as it expands its research, geographic reach and leverages its brand, Fisher says. Essentially, physicians would be given the ability to design and manage 'the most operationally efficient clinical program for care of their service line's patients across the hospital," he adds.
In developing telestroke programs, it is important to consider legal ramifications. "Unfortunately, much of medicine is defensive, it's to keep our physicians out of court," says Phil Pomeroy, vice president, neurosciences, at Barrow Neurological Institute. "Unless it changes dramatically, (we) are still locked in a very traditional and very expensive (system).
Even with telehealth our physicians who are engaged in that process have a little uneasiness. As they hand the baton (to another physician), there's 'what if and things go south, and all of a sudden everyone gets a little clammy, what are the risks and the legal liabilities? It's going to be a real challenge; it's very squishy."
Despite the risks, Pitt notes that telestroke and other telehealth programs "prompt dialogue outside the walls of traditional institutions." Tele-medicine offers the opportunity to "follow that patient as they pass through their lives."