Posted on the NeuroDox site:
We are all trying to best understand how to establish a truly pragmatic approach to broader tele-stroke, tele-neurology. I know people have been looking at InTouch, Reach, PolyCom, and different variations, but I was more interested in having us establish a set of specifications of what the “technology” needs to enable, and where the “resources” should both come from and enable, as well as optimal methods of notification and communication. The more I work with others on issues of interfacility transfer for complex neuro, stroke, neurosurgery in particular, the more obvious it is that some broader, collaborative regional approach to tele-consultative neuroscience support, including stroke, critical care neuro, neuroradiology, neurosurgery, interventional expertise, etc is needed. Whenever I can see the inevitable I feel a need to begin working toward that, not the things in between which just wont ever quite get there!. Here are some thoughts
Whatever physical devices and network setups are used for teleconsultation, a few criteria are key
It must be simple to deploy without excess dependence on local/hospital/office IT resources, technical support or even capital expense
- It must enable simple bidirectional audio/video when desired, but at least bidirectional “switch back and forth” to alternate between expert and recipient
- It must have some pragmatic mobility until such time as every single bed has the same capability in every room and location
- It must enable a multitude of experts, in different places at different times, to easily connect into it via the web, without any special hardware or complex software installed on the experts workstation, mobile, laptop, etc (this is where I struggle with the InTouch approach, to be honest)
- MOST of the money for this should be allocated for compensation of the person providing expertise and even the busy clinician taking the time to request decision support, NOT into the technology itself, given that the fundamentals of telecommunications are more ubiquitously available
- It should make the documentation of events, recording of them, etc much easier without introduction of new complex data systems or duplication of work
I know many have been working on proposals to states and regions, etc. and there are many telemedicine associations, grants, etc But it seems to me that the most important thing is for a group of neurologists and other neuroscience experts who are likely to be engaged in the provision of virtual care to map out the essential elements of capability, deployability, operational support, costs, compensation, etc BEFORE looking at specific technologies and systems. because technologies evolve quite rapidly nowadays, and most of this is overlapping with developments in the generic telecom industry
I think this is where we are heading in maryland and elsewhere, in order to more readily provide distributed decision support to ER< ICU, hospitalists, that creates a broader “virtual critical care” environment less dependent on a small number of physical neuro icu beds in a few large hospitals.
