Conference Highlights: A Decade of Telemedicine Achievements, Past, Present and Future

By Ben Boulden

Each year the UAMS-led partnership of AR SAVES organizes the conference and most of the attendees work at its partnering hospitals.

Renee Joiner, B.S.N., AR SAVES director, recounts the history of the AR SAVES program.

Renee Joiner, B.S.N., AR SAVES director, recounts the history of the AR SAVES program.

November will mark a decade that AR SAVES has used telemedicine, and its network of hospitals, to reduce the time it takes for a stroke patient to receive treatment with alteplase, a powerful clot-busting blood thinner. Telemedicine also reduces the time that separates a stroke patient from the stroke neurologist who can diagnose and help them.

UAMS’ Renee Joiner, B.S.N., AR SAVES director, told attendees that in 2008, there were 35 consultations via the telemedicine network and three patients received alteplase. Only about 38.4 percent of Arkansans were within a 30-minute drive of a stroke-ready hospital at that time. Today, there are 54 hospitals in the AR SAVES network and almost 90 percent of residents are within a 30-minute drive to a stroke-ready hospital that is an AR SAVES partner.

As impressive as the growth and development has been, Joiner said, “We need to make sure we keep the individual patients in mind when we do this. You start talking about numbers, and it’s real easy for them to become numbers. We’ve got to remember that every number represents a story.”

She recounted one of those stories she was told recently.

J.D. Day, M.D., speaks to the conference audience about hemorrhagic stroke.

J.D. Day, M.D., speaks to the conference audience about hemorrhagic stroke.

“A visitor from Michigan had a stroke while he was here visiting family,” Joiner said. “He came up to me and said, ‘Thank, God, I had my stroke here instead of Michigan.’ He said he would not have been able to get this kind of care there. We are very, very fortunate. All of you are the ones who proved that this concept could work. Without you believing in the program and  making it work, we wouldn’t be here today to talk about it. Thank you for that.”

An ‘Ask the Experts’ panel discussion featured Jennifer Smith, J.D., R.N., associate general counsel with the UAMS Office of the General Counsel; Sanjeeva Onteddu, M.D., assistant professor in the UAMS College of Medicine Department of Neurology and medical director of AR SAVES and the UAMS stroke programs; Richard Nelson, M.D., medical director for the Emergency Department at Baptist Health Medical Center in Heber Springs; and Amanda Irby, B.S.N., director of the Emergency Department at Conway Regional Medical Center and an AR SAVES nurse facilitator.

Conference attendees prepare to participate in a game that tests their stroke knowledge. Participants raised letter cards to give their answers to multiple choice questions.

Conference attendees prepare to participate in a game that tests their stroke knowledge. Participants raised letter cards to give their answers to multiple choice questions.

Smith highlighted changes in state telemedicine law enacted in 2017, including a mandate that a physician providing a telemedicine consultation be licensed to practice in the same state as their patient. Also, insurance companies are required to reimburse for the service via telemedicine as long as it’s comparable to what the patient would have received in person.

The panelists answered a wide array of questions from the audience ranging from legal questions, such as if a consent form can be signed after a patient is treated with alteplase (it shouldn’t be), to clinical questions like what a nurse should do if the physician is delayed in calling for an AR SAVES consultation.

Irby explained that to expedite the process nurses can utilize written protocols “We have protocols for a reason, I’m saying that sweetly. Many ERs have one provider and if that provider is tied up putting 16 sutures in a three-year-old’s head, or with a cold or whatever, you’re delaying that stroke patient’s care if you wait.”

About 290 people attended the three-day Telestroke Conference.

About 290 people attended the three-day Telestroke Conference.

Both Onteddu and Nelson were asked if they liked the new wording in what AR SAVES physicians tell patients to get their informed consent for treatment with alteplase. The new wording eliminates mention of the percentage chance they have at recovery from their stroke.

“When I talk to them, I usually show them a picture of 100 people that shows those percentages,” Onteddu said. “Once they see the sheet, they usually feel more comfortable. When they hear there’s a risk of bleeding, that you can die from the alteplase, it takes a back seat to knowing the stroke could be bad or worse. I usually quote the initial trial data.”

Nelson said he likes the new wording and the absence of the numbers.

“At that time during a stroke, the patient is not going to understand most of what you’re trying to explain to them,” he said. “The patient’s family isn’t either. They get lost in the numbers and don’t understand the concept. I’ve found it’s better to say, ‘There’s a chance this might happen or a chance that might happen. We think the benefits outweigh the risks,’ and go with that.”

Other featured speakers at the conference included Igor Rybinnik, M.D., a New Jersey-based neurologist; J.D. Day, M.D., chair of the UAMS College of Medicine Department of Neurosurgery; Greg Brown, Arkansas Department of Health chief of the Trauma, Public Health Preparedness/Emergency Response and Emergency Medical Services Branch; and Prabhat Hebbar, M.D., a clinical cardiac electrophysiologist in North Little Rock.

Other session topics were telehealth etiquette, hemorrhagic stroke, acute management and commonly misdiagnosed symptoms and other aspects of stroke care.

Awards were presented to several hospital stroke programs and individuals working in them. To read about the awardees, click here.