A stroke exam via videoconferencing is as effective as a bedside exam, say Harvard Medical School researchers, suggesting that this telemedicine or “telestroke” can increase patient access to stroke specialists, especially in rural or other underserved areas. The problem is, the United States has only an average of four neurologists per 100,000 people, and not all of them specialize in stroke, according to the statement in Stroke: Journal of the American Heart Association. When a stroke occurs, physicians must quickly evaluate patients to determine if they’re eligible for time-sensitive treatment such as tissue plasminogen activator that can save brain function and reduce disability. Stroke and brain imaging specialists are often required to perform the evaluation.

 

“Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance,” says Lee Schwamm, lead author of a scientific statement and policy statement on telemedicine, and associate professor of neurology at Harvard Medical School and Vice Chairman of Neurology at Massachusetts General Hospital.

 

Telestroke uses interactive videoconferencing via webcams connected to a TV or computer screen, which allows the patient, family, and both the bedside and distant healthcare providers to see and hear each other in real time, the researchers say. Telestroke is coupled with teleradiology, which allows remote viewing of brain images. This technology can broaden the reach of neurologists in a cost-effective and time-efficient manner, the researchers say.

 

But the researchers say there needs to be changes in how telemedicine activities are reimbursed in order for it to be truly effective. Among the changes: Providers should deploy telestroke systems to supplement resources where around-the-clock local, on-site acute stroke expertise is insufficient. Additionally, they recommend increasing Medicare reimbursement for telestroke assessment, diagnosis, and approval to use tissue plasminogen activator or tPA to reflect the increased upfront costs of implementation. What’s more, a mechanism for uniform, streamlined credentialing for telestroke providers and uniform national telemedicine licensure by state medical board should be developed.

 

A separate report said that transient ischemic attack, once known as a “mini” or “warning” stroke, should be treated with the same urgency as a full-blown stroke. The authors say the risk of stroke after a transient ischemic attack is greater than previously thought. Therefore, they redefined the condition to urge immediate action and thorough testing—much like the exam after a full-blown stroke.

 

“We think a TIA should be treated as an emergency, just like a major stroke,” says J. Donald Easton, writing chair of the statement and professor and chair of the Department of Clinical Neurosciences at Alpert Medical School of Brown University and the Rhode Island Hospital in Providence. “Because we know the high risk of a future stroke, this is a golden opportunity to prevent a catastrophic event.”