TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

A FOUNDING MEMBER OF

What is TeleNeurology? The TeleNeurology program is your constant access to Massachusetts General Hospital (MGH) and Brigham and Women Hospital (BWH)’s stroke specialists for vascular, general and critical care neurology emergencies. It enables real-time neurological assessments of patients who present to your hospital’s emergency department with stroke-like symptoms. The TeleNeurology consult occurs between a Partners Neurology specialist and an outside provider at the patient’s bedside review. The consult allows the MGH or BWH’s Neurologist to examine the patient, review the findings, and provide recommendations on the best possible treatment, in a timely manner. TeleNeurology currently includes the following distinct services:

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May 31, 2008. I remember it all.

 Emergency TeleStroke: 24/7 access, within 5 minutes to a stroke specialist for immediate consultations.  Emergency TeleNeurology: 24/7 access, within 5 minutes to a stroke or emergency neurologist for immediate consultations (typical cases include, status epilepticus, comas, cord compressions, Guillain-Barré, acute weakness…).

I am awakened by the slap of my right hand striking my right cheek. I cannot control or feel the action. The entire right side of my body is weak and numb. My head aches acutely and there is severe pain in my right eye. My vision is blurred. My low lip feels (and is) swollen on the right. I attempt to stand and am immediately dizzy and uncoordinated. I alert my partner and realize it is difficult to speak. I slur out my issues and call 9- 1-1 for help.

 Inpatient TeleNeurology: business hours access, within 30 minutes to a neurology hospitalist for scheduled consultations.  Outpatient TeleNeurology: business hours access, within 30 minutes, to a neurology generalist for scheduled consultations. The process of remotely treating stroke patients was pioneered by Dr. Lee Schwamm in 1996 and was launched as a pilot program. The planning phase, 1996 to 2000, enabled MGH to fine tune its processes and protocols while validating telemedicine for stroke care. In 2000, Martha’s Vineyard Hospital became MGH TeleNeurology’s first spoke. Processes and technologies have been licensed to 7+ academic medical centers and are in place in 60+ US hospitals, arguably the largest not-for-profit academic center-driven TeleNeurology network in the United States.1

I am ambulance-driven to York Hospital quickly, where I am evaluated and stabilized thoroughly by the Emergency Room Team. I am told that the hospital has communicated my details via its TeleNeurology Network with MGH and recommends that for further treatment I be transferred there (I accept and arrive at MGH within 2.5 hours of the onset of stroke symptoms). Four intensive treatment inpatient days, then transfer to the Spaulding Rehabilitation Hospital-the MGH adjunct facility- for 3.5 weeks and outpatient therapy results in complete recovery: an amazing and gratifying result. I “do gym” frequently and volunteer my time both at York Hospital and an elder service agency in Maine. None of such activities, or my recovery would have been possible without the TeleNeurology initiative.” Alan C. Nichols (Stroke Survivor)

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TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

Silva GS, et al. The Status of TeleStroke in the United States: A Survey of Currently Active Stroke Telemedicine Programs. Stroke.

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

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2014 Metrics of Success

World Class Clinical Quality Our attending staff members are all board-certified neurocritical, vascular, or general neurologists and provide the highest quality 24/7/365 TeleNeurology coverage available.

 150+ Independently-funded research grants  1,000+ Peer-Reviewed Publications  1060+ Invited Presentations

6.5 MILLION

A TOTAL OF

NEW ENGLAND RESIDENTS now with immediate access to our team of neurologists.

1,202 CASES 542 Video consults

660

Christopher D. Anderson, M.D.

Edip Gurol, M.D., MSc

Sherry Chou, M.D.

Galen V. Henderson, M.D.

Adam Cohen, M.D.

Leigh R. Hochberg, M.D., Ph.D.

Steven K. Feske, M.D.

W. Taylor Kimberly, M.D., Ph.D.

Seth Finklestein, M.D.

Thabele M. Leslie-Mazwi, M.D.

Telephone consults

Steven Greenberg, M.D.

Patricia L. Musolino, M.D., Ph.D.

207 OUT OF 532

OUT OF THE 1,202 TOTAL CASES

65%

39%

STROKE CONSULTS

MingMing Ning, M.D.

Scott Silverman, M.D.

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Jonathan Rosand, M.D.

Aneesh Singhal, M.D.

Eric Rosenthal, M.D.

Farzaneh A. Sorond, M.D., Ph.D.

Natalia S. Rost, M.D.

Henrikas Vaitkevicius M.D.

Guy A. Rordorf, M.D.

Lee H. Schwamm, M.D.

Anand Viswanathan, M.D., Ph.D.

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

over video received IV-tPA compared to four percent national rate, allowing more patients a chance to avoid stroke permanent disability, assisted living, or death.

REMAINED AT THEIR COMMUNITY HOSPITALS

4%

MGH Video TeleStroke tPA rate

National tPA rate

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

785 patients out of the 1,202 total cases

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2014 Metrics of Success

107

CASES

Beyond Clinical Care

14

Foster Education

PERCENT OF IV-TPA CASES

identified as candidates for Intra Arterial Therapy (IAT)

Community hospitals are granted full access to our online clinical learning management system, hosted at www.phscpd.org/MGHTelestroke. This is a series of CME/CEU lectures (Partners continuing professional development and the New Hampshire Nursing Association, respectively) that can be accessed from anywhere and streamed on demand through a tablet, laptop or desktop computer. Our speakers are world-renowned MGH physicians and nurses. Many are Harvard Medical® School faculty members. Certified Stroke Centers can meet the educational requirements of their certification through this component of our program.

remained in community hospitals.

748

STROKE CASES

remained in the community hospital, representing $6,000,000+ of potential reimbursement for community hospitals DRGs reimbusement.

$6,000,000+ of potential reimbursement Build a Relationship

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American Hospital Directory. Subscription Data set. http://ahd.com/. Accessed March 31 2011.

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TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

Community hospitals may leverage their relationship with MGH or BWH, top performing academic medical centers, to strengthen their brand and their position in the national healthcare system, obtain certifications and quality distinctions from certifying bodies. Our relationship oriented efforts include annual surveys, periodic check-ins and development efforts around our community of emergency and neurology care providers. The program also provides an ubiquitously accessible, robust analytics tool, that tracks, real time, all of your program’s relevant metrics of success. Our tool will offer valuable insight to your efforts to provide top quality neurology care to your community, empowering to make the right decisions to achieve your goals.

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

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Delivering World Class Care Virtually Anywhere

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CONSULT REQUEST When a patient with stroke/neurology symptoms is in need of emergent care, your team pushes the patient’s imaging studies and pages the on-call TeleNeurology specialist for a consultation.

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CASE REVIEW The TeleNeurology specialist immediately begins the assessment of the images and returns the page by phone to review the case; the consult may transition to a videoconference call, if appropriate. Using the video connection, the specialist will review the patient’s presentation with your emergency department physician and, aided by your local staff, will perform a neurological assessment and discuss the findings with you. Together you decide on the plan of care.

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

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ONLINE ASSESSMENT The TeleNeurology specialist documents the information within the TeleNeurology Web Portal. You can access the portal to retrieve your local EMR or have it sent via fax.

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

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COLLABORATIVE DECISION MAKING Upon completion of the examination, the findings will be discussed with your team. Together you decide on a plan of care.

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Inpatient and Outpatient TeleNeurology

TeleNeurology Regional Network

Bringing coordinated care to the next level

Maine Bridgton Hospital Central Maine Medical Center Mercy Hospital Rumford Hospital York Hospital

MGH TeleNeurology offers two new service lines to our community hospital partners. First, we provide same-day video consultation to providers caring for inpatients. These consultations typically fall under the category of non-acute general neurology, including such symptoms or conditions as headache, vertigo, weakness, cognitive changes, subacute stroke and seizure. The second service offers similar consultations to referring providers in ambulatory settings. Here, requests typically occur when the referring provider learns of an established patient with a new neurologic problem, such as new or intractable headache. The consultation is then coordinated between the referring provider, patient, and TeleNeurology consultant.

New Hampshire Concord Hospital Elliot Hospital Exeter Hospital Franklin Regional Hospital Lakes Region General Hospital Southern NH Medical Center Wentworth-Douglass Hospital

How does it work? Inpatient Example within 15 minutes

 38 year-old man with dizziness

 Admitted to inpatient ward  Concern for acute brain process like stroke

a few hours

 TeleNeurology specialist returns page – video consultation schedule

Massachusetts Brigham & Women’s Faulkner Hospital Cape Cod Hospital Carney Hospital Cooley Dickinson Hospital Falmouth Hospital Good Samaritan Hospital Holy Family Hospital Lawrence Memorial Hospital Martha’s Vineyard Hospital Melrose - Wakefield Hospital Mercy Medical Center Milford Regional Medical Center Nantucket Cottage Hospital Spaulding Rehabilitation Hospital St. Anne’s Hospital

 Video consultation between hospitalist, patient, and TeleNeurology specialist:  History suggestive of (benign) inner ear and acute brain process

 Hospitalist pages MGH TeleNeurology

 Exam also suggestive of benign process; normal eye movements, coordination and gait

YORK HOSPITAL

 MRI/brain MRA reviewed (both normal)  Epley maneuver performed to correct inner ear disturbance  Transfer to MGH avoided

Outpatient Example within 15 minutes

 40 year-old man h/o migraine w/ severe headache episode last week  Patient schedules same-day PCP appointment  PCP pages MGH TeleNeurology

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began in 2007. As a small community hospital, our relationship with the MGH TeleNeurology Program has been invaluable to providing our community with world-class neurology care. We strive to provide our patients with exceptional quality care delivered with compassion and kindness. The knowledge and reliability of the MGH TeleNeurology initiative fits right in with our mission – compassionate, high quality medical care experiences.

a few hours

 TeleNeurology specialist returns call; PCP requests video consultation during patient visit

“ Our hospital’s TeleNeurology Program

 Video consultation between hospitalist, patient, and MGH TeleNeurologist:

 Head CT recommended; if negative, then spinal tap

 Patient and PCP receive neurologist earlier than  History suggestive of per routine prolonged migraine, but a more ominous process  ER visit and outpatient like brain hemorrhage is neurology referral visit avoided also of concern  CT and spinal tap normal;  Remote neurologic exam headaches resolved over the week normal, including basic mental state, visual field, eye movement, speech, strength, and gait

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

Not only has TeleNeurology been able to provide us with the capability to handle acute stroke cases, they have also offered us important guidance in helping us to achieve our goal of Gold Status as part of the Get With The Guidelines through the American Stroke Association®. By achieving this status we are now aligned with the latest scientific guidance and have seen measurable results in patient outcomes and family satisfaction. The immediate around the clock access to the TeleNeurology team ensures that we can diagnose and treat our patients with a high level of clinical expertise.” John Alexander, MD Former Emergency Room Leader, Integrated Medicine, York Hospital

TeleNeurology: Connecting Patients and Neurologists Virtually Anywhere

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Interested? Join! To request more information or to become a member of our TeleNeurology network, please contact us using the methods below:  Call us at 617-724-3999  Email us at [email protected]  Visit us on the Web at www.massgeneral.org/teleneurology

Partners National Telestroke Network Expanding our Reach We have successfully replicated our model throughout multiple regions, in partnership with other top performing academic medical centers and healthcare networks. For more information, please visit us at www.massgeneral.org/teleneurology

Massachusetts General Hospital Teleneurology [email protected] | Tel: (617) 724-3999 | Fax: (617) 228-4628 55 Fruit Street | Wang 729J | Boston, MA 02114 | massgeneral.org/teleneurology