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
“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
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
Until recently, Stroke Team physicians had not been compensated for the extra
patient load. The Texas Legislature recently enacted laws to ensure reimbursement
“Telemedicine helps us do what is best for the patients,” Dr. Choi
says. “This is a solution for the current nationwide shortage of frontline