More trusts use telemedicine for stroke

More than 30 acute trusts have now adopted a telemedicine system designed to deliver fast and appropriate treatment to stroke victims.

The system, developed by NHS East of England and East of England Stroke Networks, enables consultants to talk to patients using video and audio links, view their scans from a lap-top and make decisions about prescribing life-saving drugs.

Damian Jenkinson, national stroke director, told Smart Healthcare Live in London that the technology was proven to be clinically safe and effective.

It has also been shown to deliver significant cost savings by reducing the number of people who are disabled by stroke.

Drug treatment for stroke – thrombolysis – must be delivered within three hours of the onset of symptoms to be effective. However, it is dangerous for patients for whom it is contraindicated.

Making a decision about who is suitable for the drugs requires consultant-level expertise that is not always available round the clock.

Jenkinson said: “With telemedicine, you can make the decision about prescribing thrombolysis without having to be with the patient.”

There are 110,000 new strokes in England a year and an estimated 10% of them could benefit from thrombolysis.

The telemedicine system won the 'best use of telehealth and telecare' category of the E-Health Insider Awards 2010 in association with BT.

There are now more than 30 stroke units using it, including Jenkinson's own unit at Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust.

The economic case for using telemedicine was strong, he added. He cited a QIPP business case from Lancashire and Cumbria showing that the stratgic health authority expected to make savings annual savings of £2.3m for an investment in technology of £285,000 and annual running costs of £115,000.

The business case supposed 4,000 new strokes a year in the region, of which 10% would benefit from thrombolysis.

Of this 10%, half would be seen out of hours using the telemedicine system, leading to 100 patients with significantly less disability than had they been treated without access to consultants.

Dr Jenkinson agreed that the major barrier to adoption of technology was not the business case or indeed the capital investment needed but whether clinical staff had ownership and understanding of its benefits.

He said: “I have a piece of video which shows a healthcare assistant who had not been trained to use the telemedicine take a vomit bowl and place it over the camera. Staff have to see the benefits and take ownership.”

Asked whether he was concerned about a next possible step – out sourcing his expert role to stroke specialists abroad – he said he was “willing to have the discussion”.

He said: “I think if that was adopted in the right way and with the right safety and information governance measures in place, I would be ready to have a conversation about it. I would be happy to be relieved of these duties if it could be done in a safe and effective manner.

“However, that comes with the caveat that the IT systems such as the PACS are different in each hospital. And if the interfaces are complicated here, then that would be even more complicated for an out sourced solution.”