Maryland Stroke Telemedicine Project

1
Maryland Stroke Telemedicine Project

• RMC Maryland Health Roundtable
• 9/23/08
• Eric Aldrich, M.D.
• (with minor adaptations by Dr. Stern, 10/2/08)

2
Background

• 1996 tPA approved by the FDA, 0 3 hour window
• 2000 2002 Operation Stroke
• 2005 Strike Out Stroke Maryland State Plan
• 2005 Plan approved by State Advisory Council on
  Heart Disease and Stroke, included in 2005 Annual
  Report
• 2007 MIEMSS State Stroke System
• 2007 State Advisory Council on Heart Disease and
  Stroke 2007 Annual Report includes telemedicine
  as a future goal
• 9/25/08 tPA effective and safe, 3 4.5 hour
  window (Hacke, et al. N Engl J Med
  20083591317-29

3
Current Situation

• Pre-hospital provider training has been developed
  and is ongoing
• Over 30 hospitals have become MIEMSS certified
  stroke centers
• Emergency Medicine physicians have completed
  training
• CHALLENGE Neurology Coverage

4
Telemedicine Past Experience

• 1990s University of Maryland St. Marys
  Hospital Project
• Other States Georgia, Massachusetts, Michigan,
  California, New York
• Telestroke Companies REACH MD, InTouch
• Johns Hopkins Hospital Howard County General
  Hospital Pilot Project (PACS telephone)

5
Telemedicine Costs
REACH MD

• Hub and Spoke model dedicated stroke care
• Hub 3,500 - 4,500 per month
• Spoke Hardware - 3,300 per year
• Support - 2,000 - 3,000 per
  month
• 1 Hub 10 Spokes 447,000 per year
• 24 / 7 remote system maintenance

6
Telemedicine Costs
MGH

• Hub and Spoke model
• Hub Maintains the system
• Spoke Hardware - 10,000 one time cost
• Support Annual Fee to the Hub

7
Telemedicine Costs
Neurology Coverage

• MGH Part of the annual fee
• REACH MD T.B.D. by the Hub
• Canada 250 for 24 hours, 500 if have to come
  in
• U.S. Hospitals varies from 0 and up
• Note State support for in house trauma surgeon
  coverage
• Note Possibility of 3rd party payer coverage

8
Telemedicine Future Benefits

• Benefits community hospitals with neurology
  coverage problems
• Could be used for other specialties in demand
  such as otolaryngology, orthopedic surgery,
  plastic surgery
• Could be used for emergency preparedness

9
Telemedicine Future Options

• Centralized state supported system
• De-centralized private systems
• Cooperative venture
• State / private / hospital blend

10
Telemedicine Recent Efforts

• May, 2007 REACH MD presentation at U. of
  Maryland
• InTouch presentation in summer, 2007
• December, 2007 Conference call with New York
  system
• April, 2008 DHMH brain storming meeting
• May, 2008 JHH Grand Rounds Massachusetts system
• July, 2008 DHMH follow-up meeting
• September, 2008 State Advisory Council
  resolution to develop a telemedicine proposal

11
Telemedicine Next Steps
Discussion Amongst Key Stakeholders

• State Advisory Council on Heart Disease and
  Stroke
• DHMH
• MIEMSS
• MIEMSS State Stroke System QIC
• Comprehensive Stroke Centers (possible hubs)
• Maryland Hospital Association
• Maryland Stroke Alliance
• American Stroke Association
• Other?
• health insurance providers