May 11, 2009 A new scientific statement says a remote exam using high-quality videoconferencing equipment is as effective as a bedside stroke evaluation.
Physicians must quickly evaluate stroke patients to determine if they’re eligible for time-sensitive treatment such as tissue plasminogen activator (tPA) that can save brain function and reduce disability. Stroke and brain imaging specialists are often required to perform the evaluation. However, 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.
Telemedicine, or telestroke, uses interactive videoconferencing via webcams connected to a TV or computer screen, which allows the patient, family and the bedside and distant healthcare providers to see and hear each other in full color and in real time.
Telestroke is coupled with teleradiology, which allows remote review of brain images. This technology can broaden the reach of neurologists in a cost-effective and time-efficient manner.
“Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance,” said Lee Schwamm, M.D., 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.
To be effective, however, there needs to be changes in how telemedicine activities are reimbursed, he said. For that, policy recommendations were released along with the scientific statement. The policy statement recommends:
- Deploying telestroke systems to supplement resources where around-the-clock local, on-site acute stroke expertise is insufficient.
- Increasing Medicare reimbursement for telestroke assessment, diagnosis and approval to use tPA to reflect the increased upfront costs of implementation.
- Developing a mechanism for uniform, streamlined credentialing for telestroke providers and uniform national telemedicine licensure by state medical boards.
- Increasing funding sources for stroke telemedicine programs which could include designating support from the federal American Recovery and Reinvestment Act of 2009.
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