International Stroke Conference
February 6–8, 2019

Deepak Gulati, MD

During the joint symposium on the last day of the ISC 2019 on Telestroke, multiple experts with different backgrounds addressed the challenges associated with Telestroke. Telestroke turns 20 in 2019, which reflects 2 decades of progress. It was more of proof of concepts in early 2000 while showing benefit of Telestroke in rural areas. Telestroke plays a predominant role in the ‘Drip and Ship’ model in the United States, whereas the focus has been on Telestroke-supported stroke units in Europe. In the U.S., the Congress also authorized the payment for Medicare FFS Telestroke regardless of patient location in the “Furthering Access to Stroke Telemedicine” FAST Act. The future of Telestroke research will be on value (~quality/cost) vs churn, true econometric analyses, adoption within health system, scalability, disparities in access, continuum of care and Telestroke on call expertise vs AI. Based on data provided, there appears to be a connection between door-to-needle time with the number of consults from spoke hospitals. 50% of the Telestroke consults are usually acute stroke, and the rate of IVtpa administration increases with the number of consults performed. It’s expected to have the involvement of artificial intelligence in the future to deal with increasing demand of Telestroke.

Dr. Sheila C. Martins from Brazil discussed a pilot project (started in 2008) during her presentation on “Global Trends in Telestroke Stroke Care.” There has been a dramatic increase in the number of stroke centers along with stroke units in Brazil, but there appears to be a lot of inconsistencies in the distribution of these centers, leading to a larger area without access to rapid stroke care. The poor infrastructure and low funding resources threaten the widespread use of telemedicine, particularly in low- and middle-income countries. Dr. Martins reported the successful use of smartphone app ‘Join’ in Brazil in providing acute treatment to stroke patients in remote hospitals.

Dr. Daniel Korya from CarePoint Health shared his experience as a neurohospitalist during his presentation on “Telestroke Networks in Urban Settings.” Telestroke is gaining popularity in the urban setting due to multiple reasons, including hospital systems adopting an organized model (Hub and spoke), need for access to stroke experts, and busy general neurologists. The important key features of successful Telestroke programs are organized protocols along with a coordinated multidisciplinary team approach.

During his presentation, Dr. Grant Stotts from Canada shared the legal perspectives — licensure, reimbursement, privacy and informed consent. The concern is also raised about how to provide Telestroke access to rural and indigenous populations. Stroke is an effective model for accountable care involving well-defined protocols, clear process steps and measurable outcomes. The possible Telestroke metrics for accountability include process, outcome, safety measures, patient and provider satisfaction, and technology quality.

Telestroke is an important tool for delivering stroke care to areas without access to specialists. Dr. Jeyaraj Pandian from India said “Telestroke (especially with hub and spoke model) could play an important role in India. There are associated challenges with systems of care with poor rapid evaluation of stroke patients. There is also need of collaboration with other countries in terms of telestroke infrastructure, education and research.” It should be a priority of healthcare providers, along with health care systems, to promote access to stroke care. Legal barriers exist but are less of a determent with modern technology and practices.