2009 CDC HDSP Conference, Atlanta, GA Chara Chamie, Network Coordinator Mike McNamara, Telestroke Committee Chair

1. 2009 CDC HDSP Conference, Atlanta, GA Chara Chamie, Network Coordinator Mike McNamara, Telestroke Committee Chair Regional Telestroke Model

2. Overview Who we are Northwest Regional Stroke Network What we�re doing Regional telestroke committee How it relates to you Translating to your work

3. Background Stroke systems approach is cost-effective and improves treatment time Stroke network models improve stroke care quality, outcomes, are cost-effective, and reduce disparities Stroke networks began being funded by CDC in 2000 Collaborating across state borders and leveraging efforts for regional systems change

4. Stroke Networks

5. Mission & Vision Mission To facilitate, through collaboration, equal access to high quality stroke care throughout the Northwest Vision To reduce disability and death from stroke for all people in the Northwest

6. Leadership & Structure Steering Committee ChairNick Okon, DO �Surveillance & Evaluation Committee ChairDavid Tirschwell, MD MSc �Telestroke Committee ChairMike McNamara, MSEMS & Dispatch Committee ChairSoren Threadgill, MICP  Distance Learning Committee ChairDenny Lordan Advocacy Committee ChairChris Sherwin � Network Lead EpidemiologistWendy Shultis, PhD Network Coordinator Chara Chamie, MPH 

7. Telemedicine� Why?

8. Telemedicine is the future�Cost savings, time savings, life saving� Specialty care is more accessible for rural and underserved areas Reduces geographical and financial barriers to travel Educational opportunities for rural/isolated providers Potential cost savings for rural areas

9. Why Telestroke?Why Regional? Looking at the need�

11. Looking at capacity�

12. Regional Maps of Population Within tPA* Treatment Capable Time of a Primary Stroke CenterRegional Maps of Population Within tPA* Treatment Capable Time of a Primary Stroke Center

13. Total WA population based on 2000 block level Census data: 5.9 million Population served by WA PSCs: 60 Minute Drive (74.7%) 90 Minute Drive (80.7%) 90 Minute Round-Trip Flight (82.4%)Total WA population based on 2000 block level Census data: 5.9 million Population served by WA PSCs: 60 Minute Drive (74.7%) 90 Minute Drive (80.7%) 90 Minute Round-Trip Flight (82.4%)

14. Total AK population based on 2000 block level Census data: 630,000 Population served by AK PSCs: 60 Minute Drive (46.0%) 90 Minute Drive (47.1%) 90 Minute Round-Trip Flight (50.8%) Total AK population based on 2000 block level Census data: 630,000 Population served by AK PSCs: 60 Minute Drive (46.0%) 90 Minute Drive (47.1%) 90 Minute Round-Trip Flight (50.8%)

16. Population Within tPA* Treatment Capable Time of a Primary Stroke Center (PSC)*tPA = tissue Plasminogen Activator Remember, due to our methodology these #s are likely overestimates (of the population within treatment capable time of a PSC). If patients take longer than 20-30 mins to recognize their symptoms and call 911, for example, the transport window will be shorter than that shown here. However, we must remember that these data only reflect state residents within the transport window of a PSC in their own state. The next stage for these maps is to estimate the population within the transport window of any PSC regardless of the state the PSC is in. So for example, to include ID residents served by with PSC here in Spokane. In the future, it would also be good to show the population living within the travel window of a other hospitals with tPA treatment capacity either directly or via telestroke and drip-n-ship protocols.Remember, due to our methodology these #s are likely overestimates (of the population within treatment capable time of a PSC). If patients take longer than 20-30 mins to recognize their symptoms and call 911, for example, the transport window will be shorter than that shown here. However, we must remember that these data only reflect state residents within the transport window of a PSC in their own state. The next stage for these maps is to estimate the population within the transport window of any PSC regardless of the state the PSC is in. So for example, to include ID residents served by with PSC here in Spokane. In the future, it would also be good to show the population living within the travel window of a other hospitals with tPA treatment capacity either directly or via telestroke and drip-n-ship protocols.

17. �� so what are we going to do about it?

18. Regional Telestroke Committee Chair: Mike McNamara (Montana) Members: ~40 vascular neurologists, stroke coordinators, telehealth specialists, public health, AHA/ASA, epidemiologists, nurses, and physicians. Goal: Regional consortium of stroke neurologists Available 24/7/365 to provide stroke consultations ACROSS state lines in the Pacific Northwest region 1st = Phone 2nd = A/V

19. Issues to Address�Same you will encounter Licensure Liability Credentialing Reimbursement Interoperability of technology Clinical support

20. Clinical Support Need: Won�t happen without it. Integration� Successes: Clinical support Involvement Clinical committee survey Obvious need Interweaving through existing state networks Challenges Phone vs. A/V. Not if�just when� Reimbursement

21. Liability Need: Stroke neurologists need insurance coverage to protect from malpractice Successes: Group insurance 3 Quotes received Barriers: Who will pay for it?

22. Licensure Need: Neurologists must be licensed within the state they practice What about phone consultations across state lines? Successes: Verbal support received from all five State Medical Board of Examiners Next = Written approval from all Boards Success!! Written letter = Montana Barriers: New & time-intensive Relationships relationships relationshipsRelationships relationships relationships

23. Interoperability Technology & Equipment Long-term project Tap into existing health networks who have already begun this work Tap into existing Telehealth Resource Centers

25. Reimbursement Exploring in future For this concept, not as applicable For the future�.critical

26. Translating to You Barriers are universal Successes can be shared Lessons learned will save time Telemedicine is the future�

27. Regional Telestroke Committee 2009 Call Schedule February = Oregon Telehealth Networks April = Montana Telehealth Networks June = Idaho Telehealth Networks October = Washington Telehealth Networks December = Alaska Telehealth Networks *You are welcome to join us, learn, and share*

28. Next Steps Addressing each concept one-at-a-time Sharing with you Learning from you

30. Questions & Involvement Website: http://www.doh.wa.gov/cfh/NWR-Stroke-Network/default.htm Contact: Chara Chamie, MPH Network Coordinator (360) 236-3855 Chara.chamie@doh.wa.gov Special thanks to Dr. Wendy Shultis for her epidemiological work and contributions