Telemedicine helps victims of stroke

A Massachusetts company is looking to use videoconferencing technology to extend critical care to stroke patients in rural hospitals.

Brain Saving Technologies (BST) of Wellesley is working with UMass Medical Center in Worcester and three of its affiliates to put video endpoints and dedicated Internet access in each location, which will let neurologists in Worcester consult with emergency room doctors and patients at the remote sites. The impetus behind the move is a Massachusetts law that requires emergency medical technicians to bring patients exhibiting signs of a stroke to a hospital that has a neurologist on staff 24 hours a day, bypassing nearby hospitals that might not meet the requirement. Similar laws are on the books in New Jersey and Florida, with more pending in other states.

With BST's system, stroke patients can be brought to participating member hospitals, where a Tandberg Intern II portable videoconferencing unit connects the ER physician and patient with a dedicated neurologist at UMass Medical.

The neurologist sits in a room with a Tandberg 1500 or 3000 endpoint and two screens, one to see the patient and one to view the CAT scan of the patient's head. There are two endpoints at UMass for handling multiple calls and for failover.

"The patient, family, ER physician and consulting [neurologist] all feel like they're in the same room," says Stuart Bernstein, president and COO of BST. "The patient [if conscious] can see the consulting physician and ask questions."

The consulting physician has far-end camera control and can pan, tilt and zoom the camera on the Intern II to get a better look at the patient. All of the participating hospitals use the same imaging technology, which make it easier to send high-resolution images taken at the member hospital with the consulting neurologist. The images also can be shared in the videoconference consultation using Tandberg's DuoVideo technology, although at a lower resolution, which lets the patient and family see the area of concern.

When stoke occurs, and one does every 45 seconds in the U.S., according to the American Heart Association, the first three hours are critical if a patient is going to survive and have a chance at a normal life. Bernstein says 80% of strokes are called ischemic. These types of strokes can be treated with tPA, a drug that breaks up clots, which gives patients a 30% better chance of having little after-effects three months later. With the telemedicine system, the consulting neurologist can help the ER physician administer the drug, which ups the odds of recovery.

In addition to providing videoconferencing technology, one of BST's founders developed a Stroke Code Box that sits on each Intern II used for stroke patient care. The box, like a "crash cart" used for heart attack victims, is stocked with the medications needed to quickly treat a stoke patient.

BST is working with Videre Conferencing of Quincy, Mass., to implement the system at UMass Medical and its affiliates, which have not been publicly identified but are scheduled to come online in early June. Videre helped pick out the endpoints being used, as well as set up the dedicated lines between each of the locations. It also provides 24-hour monitoring and diagnostics of the system for BST.