Telestroke Considerations Go Beyond Technology

In creating and expanding telestroke centers, there is room for variety. Some hospitals and health systems opt for running them on shoestring budgets, or for initiating co-management plans with physician involvement as crucial, integral parts of building relationships among partner hospitals as with patients.

Still, there is concern about developing telestroke programs, especially in rural areas where such networks are badly needed even as some hospital officials struggle to launch them.

These issues came into sharp focus Wednesday at a Health Leaders Media Rounds panel at the Barrow Neurological Institute, St. Joseph's Hospital and Medical Center in Phoenix, AZ. The program was titled, "Neurological Service Line Growth: Telestroke and Brain Tumor Innovations."

Through emerging pathways, hospitals are seeking to improve patient care in telestroke programs with technology as a key factor. But healthcare leaders expressed concern that while IT is good, vital partnerships and collaborations are essential for telestroke or other telehealth programs.

"I'm always looking at lowering the barrier to partnerships," says Alan Pitt, MD, attending physician in radiology and clinical informatics or the Barrow Neurological Institute. "When I look out at the table at a rural access provider, he's usually a relatively small shop and he probably doesn't have the deepest IT resources. And he's listening to you talking about partnership and the first thing he does when he hears telehealth – 'big clunky stuff that he's going to be responsible for.  He can't afford big clunky stuff that's going to sit in a closet. We've made this simple. If you have a laptop, you can participate. Telehealth is evolving very rapidly in the ability to partner. Ultimately, it's less about technology and more about the business relationships. If you can eliminate that technology barrier for them."                                                                                

Indeed, a telestroke network doesn't have to be overwhelmingly expensive and can be carried out on a "shoestring" budget, says Sarah Livesay, MS, RN, ACNP, manager of neuroscience Clinical Programs for St. Luke Hospital in Houston, TX.

She agreed with Pitt that it's not all about technology. "The key to be successful is not necessarily the technology but the relationships you form and the structure you set up with the program," she says. You really need to take a step back in planning the program – develop a process and repeat it over and over again."

Although "not anti-technology," the hospital group could not afford making a large initial investment in IT for a telestroke program, Livesay says. "We've accomplished what we've done with a laptop, a Webcam and a connection with web services." Eventually, a telestroke program is about to produce its own "downstream revenue" because it has generated patients in need who can be served in other areas, Livesay says.

Such a community-based telestroke network that maximizes downstream revenue opportunities fosters physician relationships under a sustainable neurological business model, says Rob Fisher, RN, MBA, vice-president of cardiovascular center of excellence and neuroscience center of excellence at the St. John Providence Health System in Warren, MI.

"It's a critical factor in that relationship to have transparency," Fisher says.

As Gienna Shaw wrote in HealthLeaders Media, "if there's one technology that has the potential to fundamentally change access to healthcare in rural areas, it's surely teleheath."

That's backed by the 2011 HealthLeaders Media Industry Survey of technology leaders, which found 46% of respondents already have one or more telemedicine programs in place. Another 41% say they'll have one in place in one to five years.

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."

See Also:
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