Kelly Harper, Program Manager in Neurosciences, Vanderbilt University Medical Center
If you are like 94% of Americans, according to a 2017 Pew survey, you are likely reading this on a mobile device, such as an iPad. You may also do some shopping, manage finances, or pay your bills from a tablet or smartphone. The mobile devices that make our daily lives more convenient can also be lifesavers. Literally.
In addition to assisting with tasks in our everyday lives, tablets have proven to be an alternative solution for managing acute neurologic emergencies in hospitals where neurology coverage is lacking or unavailable. These technologies are easily accessible, conveniently portable, have low implementation and operational costs, and, when implemented correctly, are secure and HIPAA compliant.
"Going forward we must remain vigilant in protecting the privacy of health information while at the same time utilizing technology to expand access to healthcare"
A 2017 study by the Centers for Disease Control found that Americans living in rural communities were at higher risk of stroke-related mortality than those living in more urban areas. This could be because these populations are less likely to have access to life-saving treatments, such as intravenous tissue plasminogen activator (IV TPA). Administration of IV TPA, however, is increased with the use of teleneurology.
Nationwide, teleneurology services are available to patients suffering from stroke and various other neurological conditions in communities without sufficient neurology coverage. These services have the potential to reduce healthcare costs and save time. Despite these benefits, hospitals in areas where the service is needed most are often still reluctant to adopt these solutions because of the high initial capital investment. The traditional telemedicine cart, which has been recommended by some professional societies, can cost thousands and may incur additionalannual feesand service contracts. These technologies may quickly become outdated and healthcare support staff working on rotating or temporary shifts may not have the proper training to operate them.
A pilot study at Emory University tested the feasibility of using smart phones to diagnosis and manage stroke. An on-site neurologist used the National Institute of Health Stroke Scale (NIHSS) to diagnose and determine the stroke severity of patients who presented to the emergency department with stroke symptoms. The patients were then reassessed by an off-site neurologist, who, using a video application on a smart phone, directed the on-site neurologist to complete the same exam. When the two scores were later compared, researchers found that the neurologists were in agreement in all but one area of the scale.
Using the findings from the Emory pilot, Vanderbilt University Medical Center (VUMC) implemented a tablet-based tele-neurology service. The service has proven that inexpensive mobile technology is a more efficient and cost-effective means of providing emergent tele-neurology care to patients in community-based hospitals that have little or no neurology coverage. For these hospitals, the cost of the tablet technology, at just under $1200, is considerably less than the cost of traditional telemedicine carts. The usability of the tablets, as well as the healthcare providers’ familiarity with these types of devices, promotes their use and efficiency.
David Charles, MD, Medical Director of Telehealth at Vanderbilt University Medical Center
Beginning with one community-based hospital in 2014 and growing to include ten hospitals, VUMC has provided tele-neurology services to nearly 5,000 patients. In collaboration with healthcare providers in the community, VUMC neurologists provide remote care that has allowed 84% of these patients to remain close to home, while being quickly evaluated and treated for a range of emergent neurologic conditions, such as stroke, seizure, and altered mental status. In addition, having 24/7 access to board certified neurologists enables many of the hospitals to obtain or retain certification as Primary Stroke Centers, making life-saving stroke care available to some populations in Tennessee where it previously was not.
Based on monthly satisfaction surveys, community-based physicians are overwhelmingly satisfied with VUMC’s tele-neurology service. Of the 78 physicians who completed the surveys, 97% reported satisfaction with the patient care provided and 92% reported feeling satisfied with the overall service.
As America’s aging population rapidly grows, so too does the need to leverage easy-to-use, affordable technologies as a way of projecting specialty care to community-based hospitals where there is a growing need. Implemented in a secure fashion that is fully HIPAA compliant, tablet-based tele-neurology has enabled healthcare providers in the community to effectively manage the care of patients in need of emergent neurologic care, allowing a majority of patients to be treated close to home and only transferred when the medical services or procedures required are not available in their communities. Going forward we must remain vigilant in protecting the privacy of health information while at the same time utilizing technology to expand access to healthcare.