Health system makes cutting-edge telemedicine affordable

With the right kind of equipment, can a video conference between an ambulance and an on-call neurologist deliver the same stroke assessment results as at the bedside in the emergency room? The University of Virginia Health System, after over one year of research, is poised to find out.

Previously, AMA Wire® brought you the theory behind the University of Virginia (UVA) Health System’s research efforts to bring telemedicine to the ambulance so they can improve care for patients who are experiencing a stroke. We recently caught up with the UVA team to find out that their telestroke model iTreat is now in action.

Andrew M. Southerland, MD, a neurologist with UVA, and his team already have provided this advanced telemedicine service to patients. “We have enrolled seven patients thus far, so it’s very preliminary,” he said. “We would like to see that number increase, and our goal for this initial phase is roughly 50 patients.”

“The ultimate goal,” Dr. Southerland said, “is to take this preliminary data and use it to inform a larger multicenter trial to test this across a variety of different health care settings. We’re trying to capture whether we can get the same accuracy of the neurological exam during ambulance transport via video that we would normally get at the bedside in our emergency room.”

Currently, UVA has mobile telestroke kits installed in six different ambulances from rural-based agencies that triage to UVA Medical Center. “We have several additional [ambulances] on the launch pad and ultimately hope to encompass our entire regional triage network,” Dr. Southerland said.

“Each ambulance is equipped with our iTREAT kit, which is a custom set up using low-cost components,” he said. The team can build a kit and outfit an ambulance right now for around $1,800. The goal is to keep it less than $2,000 per ambulance to make it widely accessible.

“Our [other] goal is to keep it portable,” Dr. Southerland said, “so that it can be taken on and off the ambulance, depending on if they’re in service or out of service, [and] keep it simple for any emergency provider to use.”

The video connection is channeled through a cellular network, securely encrypted to comply with Health Insurance Portability and Accountability Act (HIPAA) requirements. An antenna channels into a high-powered modem in the kit, which makes the ambulance a Wi-Fi environment. The video call occurs across a secure teleconferencing platform.

Because the telestroke model is currently considered a research study, it’s not intended to interfere with normal treatment for patients. A clinical protocol has been set up to enroll the patients if they are eligible and then get the video conference underway:

1. A patient has a stroke in a rural or regional community, and an ambulance agency responds to the patient.
2. EMS providers evaluate the patient on the scene using the Cincinnati Pre-hospital Stroke Scale—a three-point standard preliminary screening. If anything is abnormal, they call in a stroke alert.
3. The ambulance begins to transport the patient and calls the medical communications system to alert them that they are on their way. If the patient is eligible for the research study, the neurology team gets a study call from the medical communications center.
4. The on-call neurologist then calls the iPad that is part of the iTreat kit in the ambulance. A neurological assessment begins over a video call.
5. The neurologist takes an acute stroke history and performs the NIH Stroke Scale with the emergency provider as tele-presenter. The data is recorded and the patient is then transferred to the specified emergency department.

The AMA’s STEPS Forward™ collection of practice improvement strategies can help you use telemedicine in your practice. In the module, you will find these four steps to adopt telemedicine:

• Familiarize yourself with federal and state laws and regulations. Physicians around the country are working to pass federal legislation to allow for expanded use of telemedicine in all aspects of practice. The CONNECT for Health Act and the FAST Act both seek to open the doors for telemedicine. Look to your state medical association for information on telemedicine legislation at the state level.
• Identify a service model that best meets your goals and the needs of your patients. There are numerous service models that you could adopt in your practice. These could include: Providing direct care for your patients using videoconferencing; serving as an originating site to connect patients to other physicians; serving as a distant site by consulting with other physicians or advance practice nurses; or remotely monitoring chronic illness patients to help prevent hospital readmissions.
• Determine the technology and support needed while following all applicable privacy laws. It is important to select the right technology, keeping in mind relevant technical requirements, interoperability, sufficient bandwidth and other factors. UVA’s model uses HIPAA-encrypted data sharing lines to conduct their calls. Select HIPAA-compliant technologies (both hardware and software), and enter appropriate business agreements when implementing your own telemedicine models. You can find more technology guidance from the HRSA-funded Telehealth Resource Centers.
• Understand appropriate practice guidelines to initiate a telemedicine service model. Be sure to follow appropriate specialty clinical practice guidelines. Contact your medical specialty society for information about any clinical practice guidelines it may have related to telemedicine.

Also, be sure to adhere to all state and federal regulations that impact telemedicine practice. State medical board websites are a good resource for consulting policies and regulations in your state.

In addition, Dr. Southerland suggests that if you’re looking to implement telemedicine in your practice, “Consider reaching out to local telecom providers and wireless vendors to better understand connectivity and broadband capability in your area.”

• Get answers to your telemedicine questions
• See how the AMA is addressing the top telemedicine issues
• Learn the three ways physicians are prepping for telemedicine’s success
• Find out why one health insurer is embracing telemedicine

More than 25 modules are available in the AMA’s STEPS Forward collection, and several more will be added later this year, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.