"Mobile" TeleStroke
Mobile Tele-Health for Rural Stroke Care
Dr. John Falconer – Neurologist Kelowna General Hospital
Roberto Trasolini – 2’nd...
STROKE

- 50,000 strokes in Canada each year
- Stroke is the third leading cause of death in Canada.
- Stroke costs the Ca...
TPA - Clot Busting Drug
• Right kind of Stroke
• CT Scan
• Neurologist Consultation

3 to 4 Hours for "Clot Busting Drug"
TPA Benefit
• ~ 10% stroke patients suitable
• 1/3 Appropriate Patients Benefit
• Sometimes Miraculous
• Some dying, 20 mi...
IHA - UBC Mobile
Telestroke Pilot Study
• Kelowna Neurologists all supplied with iPads;
can see and talk with patient
• 5 ...
Kelowna
Neurology

Castlegar
Patient

Trail
CT
Face Time
$25,000

$25,000

Current "Telehealth"

$800

$800

IHA Mobile Telestroke
Connection KGHN -> LERD/Patient

vs.

C
E
L
L
U
L
A
R
Hospital/
Outside

C
E
L
L
U
L
A
R

Home or Office
Data Collection:
Date

Hospital

MD’s

Patient

KGHN

Hear & See Satisfied Improved
Neurologist Need
Care

User
Friendly

...
MediTech
ID

Age

Gender

Weight
Kg

63
Anonymous
Tracking

N/A

M=F

NIHSS

EHS

Admit

Time
Arrival

CT
Time

Transferre...
MediTech
ID

Age

Gender

Weight
Kg

NIHSS

EHS

Admit

Time
Arrival

4/5
4.64

4/5

CT
Time

Transferred FaceTime
FaceTim...
MediTech
ID

Age

Gender

Weight
Kg

NIHSS

EHS

Admit

Time
Arrival

CT
Time

Transferred FaceTime
FaceTime V-C
to anothe...
MediTech
ID

Age

Gender

Weight
Kg

NIHSS

EHS

Admit

Time
Arrival

CT
Time

Transferred FaceTime
FaceTime V-C
to anothe...
Rural Mobile Telestroke Pilot

Patient
Hear & See Satisfied Improved
Neurologist Need
Care

1.4

1.4

1.4

LEDP
User
Frien...
Rural Mobile Telestroke Pilot

Patient
Hear & See Satisfied Improved
Neurologist Need
Care

1.4

1.4

1.4

LEDP
User
Frien...
Rural Mobile Telestroke Pilot

Patient
Hear & See Satisfied Improved
Neurologist Need
Care

1.4

1.4

1.4

LEDP
User
Frien...
Rural Mobile Telestroke
– they liked it, but did it matter?
More Accurate Dx
Used TPA
Avoid TPA
Transfer
Stroke Mimic
No C...
Accuracy of Diagnosis
Enabled TPA
Avoided TPA
Stroke Mimic
Conclusion:
Conclusion:
1. iPad is a feasible Telehealth Device
2. Used infrequently; High Value when Used
3. Neurologist Driven
4. Wi...
Interior Health Authority
"Mobile" Telestroke

IHA MedIT Leads the Province
In facilitating eHealth
Thank you to IHA:
• Dr...
"Mobile" TeleStroke
Mobile Tele-Health Technology for Rural Stroke Care
Mobile Tele-Health Technology for Rural Stroke Care
Mobile Tele-Health Technology for Rural Stroke Care
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Mobile Tele-Health Technology for Rural Stroke Care

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This was presented in session E2 at the Quality Forum 2014 by:

John Falconer
Neurologist - TIA/Stroke Clinic
Interior Health
Clinical Assistant Professor, Neurology
UBC

Published in: Health & Medicine
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Mobile Tele-Health Technology for Rural Stroke Care

  1. 1. "Mobile" TeleStroke
  2. 2. Mobile Tele-Health for Rural Stroke Care Dr. John Falconer – Neurologist Kelowna General Hospital Roberto Trasolini – 2’nd year medical Student UBC SMP + Thanks to: - All the Neurologists and Emergency Room Physicians In Kelowna and the Interior Health Authority - Interior Health Authority – esp. Dr. Robert Halpenny - Interior Health Authority IT – esp. Malcolm Griffin
  3. 3. STROKE - 50,000 strokes in Canada each year - Stroke is the third leading cause of death in Canada. - Stroke costs the Canadian economy $3.6 billion a year in physician services, hospital costs, lost wages, and decreased productivity
  4. 4. TPA - Clot Busting Drug • Right kind of Stroke • CT Scan • Neurologist Consultation 3 to 4 Hours for "Clot Busting Drug"
  5. 5. TPA Benefit • ~ 10% stroke patients suitable • 1/3 Appropriate Patients Benefit • Sometimes Miraculous • Some dying, 20 minutes later ~ normal • Some dense hemiplegia, next day mild weakness only
  6. 6. IHA - UBC Mobile Telestroke Pilot Study • Kelowna Neurologists all supplied with iPads; can see and talk with patient • 5 Referring Hospital ER's supplied with iPads • Stroke Patient arrives in ER, option to have Video-Conference with Kelowna Neurologist • Pilot over 6 months
  7. 7. Kelowna Neurology Castlegar Patient Trail CT
  8. 8. Face Time
  9. 9. $25,000 $25,000 Current "Telehealth" $800 $800 IHA Mobile Telestroke
  10. 10. Connection KGHN -> LERD/Patient vs. C E L L U L A R
  11. 11. Hospital/ Outside C E L L U L A R Home or Office
  12. 12. Data Collection: Date Hospital MD’s Patient KGHN Hear & See Satisfied Improved Neurologist Need Care User Friendly Satisfied Process Improved Need To Changed Care Consult Care LEDP User Friendly MediTech ID Age Gender Weight Kg Satisfied Process Improved Need To Changed Care Consult Care NIHSS E H Admit S Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time
  13. 13. MediTech ID Age Gender Weight Kg 63 Anonymous Tracking N/A M=F NIHSS EHS Admit Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time
  14. 14. MediTech ID Age Gender Weight Kg NIHSS EHS Admit Time Arrival 4/5 4.64 4/5 CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time
  15. 15. MediTech ID Age Gender Weight Kg NIHSS EHS Admit Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time 11:11 9:49 4/25
  16. 16. MediTech ID Age Gender Weight Kg NIHSS EHS Admit Time Arrival CT Time Transferred FaceTime FaceTime V-C to another V-C call call Duration Hospital Time 6.8 min 9:49 10:58
  17. 17. Rural Mobile Telestroke Pilot Patient Hear & See Satisfied Improved Neurologist Need Care 1.4 1.4 1.4 LEDP User Friendly KGHN Satisfied Process Improved Need To Changed Care Consult Care User Friendly 1.36 1.4 1.4 Satisfied Process Improved Need To Changed Care Consult Care 1.4 1.44 1.4 Strongly Agree(1) | Agree (2) | Neutral (3) | Disagree (4) | Strongly Disagree (5)
  18. 18. Rural Mobile Telestroke Pilot Patient Hear & See Satisfied Improved Neurologist Need Care 1.4 1.4 1.4 LEDP User Friendly KGHN Satisfied Process Improved Need To Changed Care Consult Care User Friendly 1.36 1.4 1.4 Satisfied Process Improved Need To Changed Care Consult Care 1.4 1.44 1.4 Strongly Agree(1) | Agree (2) | Neutral (3) | Disagree (4) | Strongly Disagree (5)
  19. 19. Rural Mobile Telestroke Pilot Patient Hear & See Satisfied Improved Neurologist Need Care 1.4 1.4 1.4 LEDP User Friendly 1.4 KGHN Satisfied Process Improved Need To Changed Care Consult Care User Friendly Satisfied Process Improved Need To Changed Care Consult Care Changed Care: 23/25 1.4 1.4 1.36 1.4 1.44 Strongly Agree(1) | Agree (2) | Neutral (3) | Disagree (4) | Strongly Disagree (5)
  20. 20. Rural Mobile Telestroke – they liked it, but did it matter? More Accurate Dx Used TPA Avoid TPA Transfer Stroke Mimic No Change
  21. 21. Accuracy of Diagnosis
  22. 22. Enabled TPA
  23. 23. Avoided TPA
  24. 24. Stroke Mimic
  25. 25. Conclusion:
  26. 26. Conclusion: 1. iPad is a feasible Telehealth Device 2. Used infrequently; High Value when Used 3. Neurologist Driven 4. WiFi Security hampers V-C 5. Cellular V-C effective
  27. 27. Interior Health Authority "Mobile" Telestroke IHA MedIT Leads the Province In facilitating eHealth Thank you to IHA: • Dr. Robert Halpenny • Mal Griffin CIO • Many others
  28. 28. "Mobile" TeleStroke
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