1. Role of TeleStroke in Healthcare
Memorial University Medical Center
Joel Greenberg, MD, FAAN
Jessica Barker, RN

2. Memorial University Medical Center
• Memorial University Medical Center (MUMC) is a non-profit, 530-bed academic medical center in
Savannah, GA (1955).
• MUMC is a regional referral center, serving a 35-county area in southeast Georgia and southern
South Carolina. MUMC is proud to house the region’s only Level 1 Trauma Center, Children’s Hospital,
Level III Neonatal Intensive Care, and Cancer Research Laboratory.
• MUMC employees more that 4000 people and has 645 physicians on the medical staff. Our medical
education program includes 6 physician residency programs and the Savannah campus of Mercer
University School of Medicine.
Our mission: With compassion, we heal, teach, and discover.
Our vision: We will be the healthcare system of choice by demonstrating excellence in
everything we do.
Our values: Safety, trust, respect, world-class, enjoyment, and my Memorial.

4. Memorial Stroke Program Overview
• Mission: To provide comprehensive stroke care, that is patient and
family centered, outcome driven, evidence based, multi-disciplinary,
cost effective, and easily accessible to patients with complex
neurological conditions.
• Vision: To provide world-class, patient and family centered stroke
care with quality outcomes in an environment of education and
research.

6. Stroke Facts
• Stroke is a “brain attack,” cutting off vital blood flow and oxygen to
the brain
• Fourth leading cause of death (killing over 133,000 people each year)
and the # 1 cause of serious, long-term adult disability
• Approximately 795,000 strokes occur each year
• One occurring every 40 seconds & taking a life approximately every 4
minutes
• 87% Ischemic &13% Hemorrhagic
• Two million brain cells die every minute during stroke
• Women are TWICE as likely to die from stroke than breast cancer
annually
• Time Is Brain.

7. Mortality & Risk Factors
Georgians at Risk!
18% Smoke
23% Lack of Physical Activity
75% Poor Eating Habits
27% Obese
30% High Blood Pressure
37% Hyperlipidemia
10% Diabetes
Age-adjusted Stroke Death Rates by County, Georgia,
2003-2007
Georgia Department of Community Health, 2009

8. What Is TeleStroke?
• TeleStroke is the use of telemedicine specifically for stroke care.
Telemedicine is the use of electronic communication methods, such as
telephone, Internet, and videoconferencing, to exchange medical
information from one geographic site to another.
• Worldwide, people living in rural and remote areas struggle to access timely, quality
specialty medical care, primarily because specialist physicians are more likely to be
located in the urban areas.
• Only 2% to 4% of patients with stroke receive tPA (only FDA approved treatment for
acute ischemic stroke) within the first 3 to 4.5 hours of symptom onset. This lowest
percentage of tPA administration is in rural areas because of the lack of stroke experts
with experience in administering tPA.

9. TeleStroke at Memorial University Medical Center
•TeleStroke at MUMC is a web-based, telemedicine system
•Utilizing real-time audio/video conferencing between hospitals
• Neurologists have a high-speed Internet connection and videoconferencing
capabilities on a laptop, tablet or desktop computer.
• This allows the neurologist to evaluate the patient, perform a neurological
assessment, view the computed tomography (CT) scan, lab values, make a
diagnosis and initiate treatment from virtually anywhere.
•Secure network
•HIPPA compliant
•Data is collected and stored

10. Hub & Spoke Model
Hub and spoke models connect spoke hospitals to 1 hub hospital via formal
agreements to engage in stroke consultation.
• Hub hospitals typically large, academic centers with the ability to provide advanced
specialties 24/7
• Spoke hospitals are typically smaller, community hospitals located in underserved
rural or suburban areas.

11. Scientific validation studies have demonstrated:
1. The NIH Stroke Scale (NIHSS) via telestroke is reliably performed by physicians
and non-physicians
2. Neurologists can reliably interpret brain CT images for the purpose of
confirming the diagnosis of acute ischemic stroke and establishing eligibility for
IV-tPA
3. IV -tPA can be administered safely through telemedicine and with outcomes
comparable to those observed in patients being treated at tertiary care facilities.
4. Audio-video telemedicine evaluation of an acute stroke patient leads to better
decision-making and safety than telephone-only consultations.
5. Telestroke networks have proven cost-effective.

12. Benefits of TeleStroke Implementation
• Builds regional relationships
• Decreased travel time and expenses for doctors and patients (decrease
unnecessary transfers)
• Improvement of access to neurological expertise for remote or underserviced
areas
• Reduction in geographical disparity for neurologic care
• Decreased response time in acute stroke
• Increase the number of eligible patients who receive IV-tPA
or other time sensitive interventions
• Improve patient outcomes, decrease stroke related
disability, and reduce health care cost
• High patient and family satisfaction survey scores

13. Barriers to TeleStroke Implementation
• Disruption of traditional doctor–patient relationship
• Physician reluctance to adopt novel technology in practice
• Limitations to billing and reimbursement for time spent
• Additional costs for technology
• Licensing, credentialing issues for out-of-state physicians
• Concern for malpractice liability
• Performing complete neurological examination
via telemedicine

14. MUMC’s Telestroke Program
Developed & implemented telestroke portal (2010-2011)
• Memorial Stroke, Savannah Neurology Specialist, Georgia Partnership for
TeleHealth, Second Opinion
• “Go-Live” April, 2011
• Bacon County Hospital Alma, GA (4/11)
• Jeff Davis Hospital Hazlehurst, GA (7/11)
• MUMC’s Emergency Department (8/11)
• Lower Oconee Community Hospital Glenville, GA (6/12)
• Meadows Regional Medical Center Vidalia, GA (7/12)

15. TeleStroke Utilization
Year Number of Number of Number of Percentage of Total Number
Regional Neurological Patients Patients of Patients
Spoke Sites Consultations Treated with Treated with Treated with
IV-tPA IV-tPA via IV-tPA at
Telemedicine MUMC
2011 3 14 2 14.3% 31
2012 5 33 19 57.6% 65
2013 5 8 4 50% 10
(YTD)
Per the American Academy of Neurology, teleneurology has demonstrated clinical effectiveness in
increasing access to neurological expertise, reducing patient and physician travel time, fostering
communication and coordinated care, and improving physician productivity.

16. WJCL News Segment….

17. Future Use of TeleNeurology
Although teleneurology is most commonly used in treating acute stroke and
neurocritical care, in the future teleneurology could potentially have a role
in managing patients with:
• Neurologic consultation is diseases such as epilepsy, dementia, Parkinson’s
disease and other movement disorders
• Neurologic outpatient referrals or consultations
• Rehabilitation referrals
• Potential consultations with regional experts

18. Questions?