The stroke doctor is in - across Texas

Bringing Stroke Team expertise to patients via telemedicine

By Darla Brown

So what if you are not in Houston when you have a stroke? What if you’re in Port Lavaca for a weekend fishing trip, or in Beaumont on business? Since time is of the essence, chances are you won’t be able to make it back to the Stroke Team’s territory to receive their expert care.

Don’t worry – since you can’t come to them, they will come to you. Through the power of telemedicine, even if you are hospitalized for stroke in Port Lavaca, Angleton, Weimer, Beaumont, El Campo, or Yoakum, you may have access to the UT Medical School’s Stroke Team.

Transmitting real-time images and sounds via data lines all leading to the emergency room at Memorial Hermann Hospital, clinicians at participating outlying hospitals are able to show Stroke Team members their patients and talk through therapy options.

“We first get a page on the t-PA pager, and we triage the situation by phone to get an idea whether the patient may be an appropriate thrombolytic candidate,” explains John Choi, M.D., director of the Stroke Team’s telemedicine program. “If we need to, we can then talk directly with the patient and observe the patient through the telemedicine equipment. We can also look at their CT scan and talk to the nurse.”



The team’s first telemedicine site was set up in 2004 in two hospitals in neighboring Beaumont – Memorial Hermann Baptist Orange and Memorial Hermann Baptist Beaumont.

“Within nine months of the program, we treated 13 patients with t-PA at these two hospitals. The year before, without telemedicine, only two stroke patients at these hospitals received t-PA,” says Dr. Choi, assistant professor of neurology. “Our review has found therapeutic responses equal to patients with in-person treatment at Memorial Hermann Hospital.”

Eighty percent of the patients on which the Stroke Team consults via telemedicine have been transported to Memorial Hermann Hospital for follow-up t-PA management.

“At Memorial Hermann, we treated 84 patients with t-PA last year, so we can evaluate who a good candidate is for this treatment,” Dr. Choi explains.

Before turning on the live connections in distant hospitals, Stroke Team officials work with local EMS crews and emergency room staff to familiarize them with the equipment and the types of patients to refer to the Stroke Team.

“We want to get the nurses into the habit of calling us,” Dr. Choi says.
Telemedicine is not just a fit for the smaller, rural hospitals that may not have stroke experts on staff. The UT Stroke Team has one telemedicine site set up in Houston – at Memorial Hermann Southwest Hospital.

“Even though it’s in Houston, it’s a good 20 minute drive for us to get out there,” Dr. Choi says. “The equipment there is set up in the emergency room, but it can be wheeled up to the neuro-ICU so that we can provide a continuum of care from afar.”

Although it seems like the Stroke Team could be stretched thin by adding patients from nine additional hospitals, Dr. Choi says it is manageable.

“It is physically less demanding to have telemedicine than in-person visits, and our telemedicine equipment is located within the Memorial Hermann Emergency Department, which allows for flexibility should acute stroke patients present both on site and remotely,” Dr. Choi says, adding that a telemedicine consult takes about half of the time of an in-person visit.

While the price of cameras and telemedicine equipment has fallen in recent years, the cost of running and maintaining data lines to rural areas can be prohibitive. The U.S. Army has given a grant of $824,000 to fund this Memorial Hermann telemedicine network. Phonoscope Healthcare Inc. is the entity assisting with establishing this network.

Until recently, Stroke Team physicians had not been compensated for the extra patient load. The Texas Legislature recently enacted laws to ensure reimbursement for telemedicine.

“Telemedicine helps us do what is best for the patients,” Dr. Choi says. “This is a solution for the current nationwide shortage of frontline stroke specialists.”