Yesterday, Healthcare Informatics hosted a webinar that explored a solution being utilized in some areas of the country to make effectively treat stroke patients. Three speakers discussed the benefits of REACH, a Web-based system enables neurologists to hold consults with patients via the Internet and order administration of medications without either having to travel to a distant facility.
First up was Sandeep Agate, CEO and president of REACH Call, who explained that the primary reason for poor stroke care in the United States was the lack of neurology experts present in most ERs. With a shortage of neurologists on hand, patients are often transferred to larger facilities that are better equipped to determine what kind of stroke he/she has had (or if in fact a stroke did take place) and what actions are necessary. According to Agate, tPA is only FDA-approved treatment for ischemic stroke, and it must be administered within three hours from onset of symptoms; however, by the time a patient in a rural area is taken to larger-staffed hospital, it’s often too late for tPA.
With the REACH system, neurologists can use laptops to remotely treat, evaluate, diagnose and recommend treatments for stroke patients. How it works is simple:
· EMS notifies the ER by radio of potential stroke victim
· ER notifies radiology to prepare for CT scans immediately upon patient arrival
· Nurse positions REACH cart (which holds wireless laptop and camera) at foot of patient’s stretcher in ER treatment room
· REACH neurologist reviews CT images, performs patient assessment via camera, and determines if tPA should be administered
Lisa Tucker, CIO at McDuffie Regional Medical Center, a 47-bed facility based in Thomson, Ga., spoke of the success her facility has had using the system. Since adopting the system in 2003, McDuffie has had 113 REACH consults and administered tPA more than 22 times.
At the Medical College of Georgia, the staff was often faced with stroke victims who were admitted from facilities that didn’t have a neurologist, and by the time they arrived (some from as far away as 200 miles), it was too late for the medication, according to Bill Hamilton, assistant professor in the department of neurology.
The REACH network, he says, enables facilities like MCG to better serve stroke patients in the state and allows neurologists to be “100 percent mobile.” One physician did a consult from Taco Bell, while another evaluated a patient from his beach house. Patients are also seeing benefits, he says, as the onset to treatment time for stroke victims at MCG is 128 minutes in rural sites, compared to the national average of 148 minutes.
There are, however, reimbursement issues that are still being ironed out. According to Agate, physicians have reported success with private payers but are having issues with Medicare, which shouldn’t surprise anyone. He is seeing “an
uptick in reimbursement guidelines” that he finds encouraging, and hopes will lead to more adoption of the system.