Presentation by Dr. Eric M. Aldrich, VP for Medical Affairs, Howard County General Hospital, Johns Hopkins Health System

1. Telemedicine and Stroke Care in
Maryland
Dr. Eric M. Aldrich
Vice President for Medical Affairs
Howard County General Hospital
Johns Hopkins Health System

2. Maryland Demographics
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Population : 6 Million

Racial/Ethnic Composition:
 White (60%)
 Black or African-American (30%)
 Hispanic (5%)
 Asian or Pacific Islander (5%),
 Native American(< 1%)

Rural Demographics :
 29% live in state-designated rural jurisdictions (1.6 million)
 7% live in federally-designated rural jurisdictions (390,000)
 Over-65 population is highest in federally-designated rural areas
(15.6%)
 Lower Median household income in state rural and federal rural areas
compared to state
 Higher prevalence of poverty and unemployment, lower educational
attainment in federal rural areas

3. Emergency Medical Services:
MIEMSS
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Maryland Institute for Emergency
Medical State Systems
Independent state agency
Directed by Governor’s EMS Board
Oversees and coordinates all aspects of
Maryland’s EMS system
 Education
 Communications
 Designation
 Licensure/regulation
 Public education/prevention

4. A Brief History of Stroke in Maryland
1996
1999
2002
2003
2004
2004
2005
2006
2007
FDA approves tPA
ASA “Operation Stroke” Program
State Advisory Council on Heart Disease and Stroke
MIEMSS creates pre-hospital stroke care protocols
JCAHO Primary Stroke Center Certification Program
“Operation Stroke” program ends
ASA Stroke Systems of Care Program
Maryland State Stroke Systems Plan
MIEMSS Stroke System created
MIEMSS certification of stroke centers

5. History of Telestroke in Maryland
2007
2009
2010
2011
2012
Bi-annual Report of the State Advisory Council on Heart
Disease and Stroke identifies the need for telemedicine
State Advisory Council on Heart Disease and Stroke
again identifies the need for telemedicine.
Preliminary discussions with DHMH begin
Maryland Health Care Quality and Cost Council
Telemedicine Task Force (White Paper)
Telemedicine bills proposed to the General Assembly
DHMH assigns MIEMSS and MHCC to direct a broader
Maryland Telemedicine Task Force (Full Report)
New Telemedicine bills proposed to the General Assembly

6. Maryland Telemedicine Task Force
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Clinical Advisory Group
Technology and Standards Advisory Group
Financial and Business Model Group
Final Report: December 2011

7. Telemedicine in 2012
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Currently several bills before the General Assembly
Cover a variety of topics including: Medical Issues,
Licensing, Credentialing, Technical Standards and
Reimbursement
Efforts hindered by the current economic environment

8. Lessons Learned
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All politics is local: Originally began as a grass roots effort
Played to our strengths: MIEMSS
Friends in high places: Gained real momentum by handing off the
leadership role to key state agencies
Know your enemy: Maryland tends to take the approach of plan,
coordinate and centralize
Divide and conquer: Identified specific problems to work on
Money talks BS walks: Kept the business aspects in mind
Strength in numbers: Went beyond just stroke (other clinical uses)
Patience hath virtue: Keep the long term goal in mind