Telestroke Technology Addresses Neurologist Shortage in Rural Areas
By Sheanna Spence
When it comes to diagnosing and treating a stroke , every second counts . During an ischemic stroke , more than 32,000 neurons die each second — that ’ s 1.9 million brain cells every minute .
An aging population coupled with rates above the national average for obesity , diabetes and heart disease have led to stroke becoming the fifth leading cause of death in West Virginia , according to the Centers for Disease Control and Prevention .
Marshall Health and Mountain Health Network member hospitals Cabell Huntington Hospital ( CHH ) and St . Mary ’ s Medical Center are part of a statewide effort through which neurologists collaborate with primary care and emergency department providers to deliver a formalized network of virtual stroke care , or telestroke , to patients in largely rural areas of West Virginia .
“ The scarcity of neurologists in West Virginia is particularly felt in our rural and community hospitals ,” says Marshall Health neurologist Justin Nolte , M . D ., an associate professor of neurology at the Marshall University Joan C . Edwards School of Medicine who oversees CHH ’ s Advanced Primary Stroke Center . “ We ’ ve been working on a way to use the technology behind telemedicine to provide stroke care to communities where it doesn ’ t make sense to have a dedicated neurologist because of patient volume .”
Telestroke pairs a Marshall Health , CHH or St . Mary ’ s neurologist with the patient ’ s emergency department care team at their local hospital to provide acute care and treatment locally . Through this treatment process , remote oversight and instruction are delivered virtually by an experienced neurologist .
“ The whole concept behind telehealth is to keep patients local when possible ,” says Nolte , who also serves on the West Virginia Stroke Advisory Committee . “ This reduces stress on the patient physically and financially and allows our trauma centers to care for patients who can ’ t be cared for elsewhere .”
In the event of a stroke , timing is everything . There is a three- to four-and-half-hour window in which tissue plasminogen activator , an injection that dissolves blood clots and helps restore blood flow to the brain , can be administered . There is also an opportunity with certain patients for specialized radiologists to remove the blood clot .
“ In order to expedite timely transport of those patients to facilities with specialized radiology services , we have to be able to identify them early ,” says Nolte . “ As local neurologists who know the terrain , we ’ re not only thinking about the condition of the patient , we have to consider length of transport in order to diagnose and treat the patient in a way that improves long-term outcomes .”
He also believes providers need to make the services easily accessible and convenient for patients , and artificial barriers and restrictions should be removed from regulations and statutes governing telehealth .
Mountain Health Network unveiled its Mountain tele- HEALTH mobile app in 2020 , available through the Apple Store and Google Play .
“ The greatest benefit is you don ’ t have to leave home to get the care you need ,” says Campbell . “ Mountain teleHEALTH is a faster , easier way to see a doctor from your home , vacation spot or business trip .”
Experts across the state agree that providing access to broadband in rural areas is the state ’ s number one hurdle to jump before telehealth services expand .
“ It ’ s tough being a mountainous and a rural state ,” says McCallister . “ The amount of money it takes just to get to one household when we ’ re talking about fiber optics is a large sum and a large amount of infrastructure , but I think it has to be the number one focus . Chipping away as quickly as we can at those pieces of infrastructure is going to be the most impactful because the technology is there . We just need to make sure every person in West Virginia has equal access to it .”
Looking forward , the state ’ s health systems have major plans to expand upon the telehealth services they ’ re currently providing . CAMC is working on increasing its telemedicine offerings for cardiology visits as well as developing hubs in Southern West Virginia connecting rural patients to a CAMC specialist without having to travel to Charleston .
“ Overall , I think the future of how patients interact with medical providers will become a blend of in-person and telehealth , sometimes even in the same encounter ,” says Harless . “ We are learning how to use this technology as a tool , which if we apply correctly , will be able to solve a lot of issues that have hindered health care for years . I believe telehealth will play a part in how we address the physician shortages that are predicted to become greater over the next 20 years .”
Davis Health System recently implemented its Care-A-Van feature , which is a mobile unit that can travel for checkups and administer vaccinations , amongst other services .
While prior to the pandemic Thomas Health was not using telehealth to provide care , the system is currently working with WVU Medicine ’ s neurology department to provide telestroke services in its emergency department . By using an iPad on wheels , a neurologist in Morgantown will be able to help a physician in an emergency department evaluate a patient who may be having an acute stroke and decide if patients are candidates for clot-busting medications , according to Upton . Thomas Health is also looking to expand telehealth services with partners to supplement other areas of care in its facilities .
“ Telehealth is here to stay . The services it will provide will only expand with time and better connectivity ,” says Upton . “ COVID-19 has pushed health care into a new model of care . Gone are just the traditional office appointments and labs every few months . What is coming will be a more interactive relationship between patients and their health care team using telemedicine as a bridge between multiple parties to interact and share visits and data electronically to improve patient-centric care . Using technology and clinical staff as an extension of the physician will allow for improved care and better outcomes .” •
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WEST VIRGINIA EXECUTIVE