AcuteCare Telemedicine Blog


Extreme Telemedicine and the Urgency of Now

January and the New Year bring the Consumer Electronics Show, an exposition of tremendous scale where the newest and flashiest concepts and prototypes for technological marvel are put on display for the public. Innovation in medicine was a hot-button topic at this year’s show, as more and more attention has been focused on the state of the US healthcare system.

There is a new television commercial from a leading innovator in communications technology making its rounds. A segment of the ad shows a group of climbers on a snow covered mountain communicating with a doctor on a tablet computer. The doctor is explaining how to set the apparently broken leg of one of the members of the crew. This 5 second scene, interspersed with other vignettes displaying the company’s visions for the future of its technologies, is an intriguing and exciting flash forward into the vast potential that telemedicine holds for the future.

Of course, one could imagine countless such scenarios in which powerful telemedicine will eventually play a game-changing role. We are on the cusp of a huge revolution in medicine, fueled by relentless innovation like that on display at CES or in the television spot.

The fact of the matter is that telemedicine has already brought this future to our doorstep. While the ‘dreamers’ consider what capabilities advanced technology might ultimately unlock, many physicians are already working with very advanced tools to address issues that are urgent now. For AcuteCare Telemedicine, the focus remains on offering sustainable and highly effective resources to deal with the increasing prevalence of stroke and other neurological emergencies. Through means made possible by telemedicine, ACT is already hard at work shaping the future of the fight against this epidemic.

Allocating resources towards new and innovative technologies and practices is an important part of creating tomorrow’s healthcare culture equipped with the right tools to care for patients. But it is also imperative that until we achieve that goal, we concentrate on applying the amazing technology already available to us to focus on the task at hand. In solving today’s problems, we set the stage for a better understanding of where to go next.



AcuteCare Telemedicine in 2013: Cutting Edge Neurological Care, Anywhere

Following a third consecutive year of growth in 2012, AcuteCare Telemedicine (ACT), an Atlanta-based partnership of 4 board-certified neurologists, is expanding its efforts to become the leading provider expert neurological care to rural and underserved areas throughout the Southeastern United States via cutting edge telemedicine technology.

Telemedicine, once regarded as an exciting new frontier, has now been fully realized as a part of the mainstream lexicon of medicine as we enter 2013. For a large number of hospital systems, telemedicine programs are now becoming a mandate as the nation faces a growing shortage of specialized physicians.

ACT has established itself as an innovator on the forefront of the industry, taking a unique approach to telemedicine by leveraging new technologies and techniques to enable personal neurology consultation when doctor and patient are in different locations. ACT offers a broad range of customizable services including 24/7 emergency neurological consultation and support programs for facilities seeking Joint Commission accreditation as a Primary Stroke Center, but primarily specializes in telestroke: the application of telemedicine to the treatment of the acute stroke patient. With the help of ACT’s powerful and personalized services, patients throughout the ‘Stroke Belt’ states of the Southeast have drastically improved access to the care they deserve, and medical facilities increase efficiency while reducing the costs associated with maintaining a traditional emergency neurology staff.

Whereas many hospitals with existing neurology departments simply do not have the resources to maintain around-the-clock clinician capacity, ACT has managed to successfully disrupt the trend and bring patient and physician together, regardless of geographical boundaries. Achieving this goal requires a certain level of investment in technology and trust in the people behind it. ACT is truly technology-agnostic.  This agility affords healthcare organizations with the ability to select the platform that meets budgetary and organizational parameters.

ACT provides access to the best 24X7 acute neurological care. Contact Michael Woodcock to hear how teleneurology can impact your business and patients in 2013.



Think of Your Brain!

It is without a doubt the most vital organ in the human body, but too often we neglect the importance of taking good care of our brain. The development and organization of the brain are incredibly complex, but the intricacies of this central body belie the simplicity of its proper day to day caretaking. We only get one – why not give some thought (pun intended) to it.

Prevention of traumatic head injuries is likely the most obvious consideration for avoiding significant damage to the brain. Unfortunately, we cannot always predict when an accident might occur, but we can take basic steps like fastening our seat belts while riding in automobiles and wearing helmets when engaging in physical activities carrying risk of trauma. Beneath the skull, we must be concerned with degenerative disorders of the brain affecting motor skills and cognition, such as Alzheimer’s Disease and Parkinson’s. Depression and anxiety also afflict millions of individuals across the country. It is important to remember that although our fast paced, high-stress lives can seem overwhelming, these conditions are chemical, and there are measures we can take to mitigate their negative effects.

Perhaps the most severe threat to the brain is stroke and other cardiovascular disease. The American lifestyle has taken a significant toll on the health of the blood vessels that deliver vital oxygen and nutrients to the brain. We have seen it most exaggerated throughout the southeastern US, a part of the country known as the ‘Stroke Belt,’ where residents face significantly higher rates of stroke morbidity and mortality.

The experts offering advice to citizens on how to minimize their risk of stroke sound like a veritable broken record; sleep more. Eat better. Exercise. Although stroke care has made huge advances in technology and technique over the course of the past decade, there is truthfully no more powerful plan of action than that of prevention. Telemedicine may soon be able to play a bigger role in opening lines communications between physicians and patients at risk of having a stroke, helping them take the necessary steps to avoid an emergency situation where the health of their brain and their life are in danger. As neurologists become more familiar with the advantages of new telemedicine technologies, they are realizing that the “ounce of prevention” is more readily available than ever before.



Stroke Treatment Gets a Boost

Fifty years ago, the only advice medical textbooks gave physicians for someone suffering with a stroke was to put him to bed and keep him comfortable, hoping that with time, the brain would heal as best it could. For 30 years, promising techniques preceded disappointing trials. First, heparin was going to be the savior, and for most of the 70s and 80s, it almost served as a standard, but better studies eventually showed that the treatment was not just worthless, but in reality dangerous, causing more brain hemorrhages than no treatment at all. Later, drugs that were intended to clear out “free radicals” were going to save the ischemic penumbra, part of viable brain tissue around a central core of dead cells, but all studies showed that either the medication didn’t get to the target, didn’t work, or could even be toxic to the brain.

In the mid 90s, tissue plasminogen activator (TPA), long used for heart attack victims to break up the clots inside arteries of the heart, was shown to be effective in doing the same in arteries of the brain. For the first time, physicians had something to offer patients that actually made a difference. About a third of patients who received TPA had better three month outcomes than those that did not. This success rate was quite good, but patients with severe strokes still did not respond as well because, in most cases, thrombi in the large arteries were not effectively dissolved.

Only in the last few years have studies been done to consider the effectiveness of a thrombectomy, the process of physically pulling out a thrombus inside an artery in the brain or neck, The early devices available to physicians are fairly good at the task, but a substantial number of patients continue to suffer from residual blockages of the arteries following the procedure.

A report of clinical trials using two new types of thrombectomy devices, called Solitaire and Trevo Retriever, show both of these new devices as being up to five times more effective than their predecessors in opening up arteries. Advances this drastic are rare in medicine, but physicians should be optimistic about the potential for these instruments in improving outcomes. Provided that patients can have access to skilled practitioners in time, within eight hours or sooner, the treatment of stroke may be about to enter a dramatic new phase.

Stroke is the most serious disabling condition in adults, resulting in hundreds of thousands of permanent injuries and deaths every year. This decade may witness the greatest advances in the history of stroke treatment. There are still further trials to run, but with these exciting new prospects, the importance of stroke neurologists like the doctors of ACT being present in every emergency room, either in person or by remote presence, cannot be overstated.



Stroke Mimics in the Emergency Setting

The role of the neurologist in treatment of acute stroke often focuses on the decision to use clot busting medication (tissue plasminogen activator; tPA), recommending care setting (e.g. ICU vs routine admission) based on patient deficits and prognosis, and of course, patient education in the midst of this emotionally charged experience. However, an often overlooked mandate for the neurologist is the proper recognition of stroke itself. Dr. J. Stephen Huff, Associate Professor of Neurology at the University of Virginia, provides a clear and comprehensive review of what are termed stroke “mimics” – disorders which may appear to be a stroke, but are not.

Stroke, broadly defined, is any prolonged disruption of focal neurologic function due to decreased blood flow from blood clotting in a specific region of brain. If that disruption is transient or intermittent it is typically referred to as a transient ischemic attack (TIA). If brain function is disrupted by a cause other than a blood clot, treatment with tPA may not only lack benefit but expose the patient to unnecessary harm. Recognition of “stroke syndromes” that result from specific artery involvement is the bread and butter of neurology. The abrupt onset of aphasia (language deficit) and right sided weakness almost certainly indicates a patient has blocked their left middle cerebral artery. Blocking this same artery on the right results in the classic presentation of left sided weakness and “neglect,” an inability to recognize one’s own physical deficits. In either case, the immediate administration of tPA can be life-saving.

Other disorders may cause brain dysfunction unrelated to a blood clot. This is the case in approximately 13-20% of patients presenting with presumed stroke. If the duration of symptoms is unclear, this number may even be as high as 30%. The most common mimic is seizure. Excessive electrical and chemical brain activity may result in focal weakness (Todd’s paralysis) and other deficits. If the seizure was not witnessed (especially in patients with previous stroke as the cause of seizures), excluding an acute stroke can be difficult. Focal neurologic injury from brain tumor, inflammation (e.g. multiple sclerosis), or even peripheral nerve palsy may be mistaken for stroke.

Stroke can be mimicked without direct injury to the brain. The most common mimic in this category is a complex migraine in which visual disturbance, weakness, numbness and even aphasia can occur. Hypoglycemia or, less often, hyperglycemia (low and high blood sugar) can cause general symptoms of lethargy or coma, but focal brain dysfunction (particularly weakness) often occurs and can outlast normalization of blood glucose. Finally, 30% of patients presenting with psychiatric causes of physical illness (i.e. conversion disorder) exhibit neurologic deficits, typically weakness.

Determining the cause of a patient’s deficits can sometimes be accomplished in an emergency setting through the use of CT imaging and appropriate diagnostic tests. Often the results of serial examinations, detailed history and, increasingly, advances in MR imaging can eventually lead to the correct diagnosis. However, certain diagnoses, notably migraine and conversion, are diagnoses of exclusion, so repeated events and extensive negative testing may be required for confirmation.

Among patients presenting with neurologic deficits, emergency department physicians correctly identify stroke before applying diagnostic studies in about 75% of cases. This means as many as 1 in 4 cases are incorrectly diagnosed. It is the role of stroke experts, like those of AcuteCare Telemedicine, to quickly and accurately determine the likely cause of neurologic deficits, the risks and benefits of multiple treatment options and convey a plan of action simply yet fully to the patient and loved ones. It is a difficult but rewarding task.



Good Things Come in Small Packages

As the fall approaches and we reach the third anniversary of AcuteCare Telemedicine, we have spent some time reflecting on our company and personal growth over the last three years. From simple beginnings, serving one health care facility in the metro Atlanta area, ACT has expanded to include facilities in rural communities of both Georgia and Tennessee. We have developed alliances with Emory University Hospital and the Georgia Partnership for Teleheath, two partners who enable us to provide the highest quality of acute neurologic care where it may otherwise be lacking. Turning our attention forward, ACT continues to push to ensure that every emergency department is staffed with adequate 24/7 neurology coverage, whether in person or via remote presence.

ACT has always believed that our successes are primarily due to the quality of services we offer. Despite our expansion over the past three years, ACT has remained a small, intimate company, still owned and operated by its four founding physicians. We find unique value in our size; it allows for outstanding continuity of care, frequent “meetings of the minds,” and quick, effective identification of problems and subsequent solutions.

Weekly meetings with all four physicians cultivate innovative ideas, enable problem identification, and facilitate the creation of solutions in a timely and efficient manner, advantages rarely possible in larger corporations. Thanks to the size of the company, each physician of ACT has a specific role, but can be flexible and share duties when needed, strengthening the consistency of the quality care we provide.

Being smaller has other rewards. In the world of acute neurological emergencies, there is little time for complex communication and red tape. When problems or concerns arise at any of our serviced facilities, an ACT physician can immediately make contact remotely and work directly with a facility member on issue resolution. Try calling up the CEO of your car’s manufacturer when your check engine light comes on.

The four physician-owners of ACT continue to practice neurology in a group that has been caring for patients for more than 65 years combined. We are highly trusted neurologists in our own community, and we are committed to bringing our expertise to other communities in need. Our small size ensures that we will stay focused on keeping our standards high and our integrity intact along the way.



ACT Speaks at Connecting Alabama Summit

AcuteCare Telemedicine (ACT) Partner Dr. Keith Sanders and Sales Executive Michael Woodcock are travelling to Prattville, Alabama to attend the first annual Connecting Alabama – Telehealth and Broadband Summit from October 17th – 19th.

The event is hosted by Connecting ALABAMA, a government-sponsored initiative working with citizens and community leaders from across the state to improve high speed internet deployment, and the Alabama Partnership for TeleHealth, a charitable nonprofit corporation with a focus on increasing access to healthcare through the innovative use of technology. Together, the organizations hope to provide an opportunity to extend telehealth services throughout all 67 counties of the state.

Topics of discussion at the event range from technical considerations, to the state’s role in deployment, to policy issues, to the current state of telehealth.  Dr. Sanders will speak on Thursday, October 18th about the future of telemedicine, specifically stroke teleneurology. The work of Dr. Sanders and the other physicians of ACT in the field of teleneurology is particularly relevant in any discussion of healthcare in Alabama, as the state is located in the region of the southeastern United States known as the ‘Stroke Belt’ for its unusually high incidence of stroke and other cardiovascular diseases.

Dr. Sanders’ presentation will address necessary tactics for successful and sustainable implementation of telestroke programs, and the characteristics of effective regionally-oriented stroke care that are enabled by telehealth. “I am excited for the opportunity to share ACT’s vision of extending expert neurological care throughout the rural and underserved parts of Alabama and the rest of the country,” says Sanders. “Opening the dialogue at this inaugural event is a key step towards achieving a future with a better standard of care in a more interconnected world.”

For more information about ACT, visit www.acutecaretelemed.com.