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Maryland Stroke Telemedicine Project

Maryland Stroke Telemedicine Project. RMC Maryland Health Roundtable 9/23/08 Eric Aldrich, M.D. (with minor adaptations by Dr. Stern, 10/2/08). Background. 1996: tPA approved by the FDA, 0 – 3 hour window 2000 – 2002: “Operation Stroke” 2005: “Strike Out Stroke” Maryland State Plan

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Maryland Stroke Telemedicine Project

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  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 2008:359;1317-29

  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 • 1990’s: University of Maryland – St. Mary’s 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 • 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 Discussion Amongst Key Stakeholders

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