Telemedicine for Stroke Care: Key Aspects
In healthcare IT since 2005, ScienceSoft offers consulting and development of stroke treatment telemedicine software.
Telestroke connects experienced vascular neurologists from a neurological center with several remote emergency care hospitals to provide online consultations on efficient treatment of patients with stroke symptoms using telehealth technology and remote patient monitoring.
With a telestroke solution, patient care is delivered as follows:
Telemedicine is effectively used to diagnose and help treat all major stroke types:
- Ischemic stroke – brain dysfunction caused by lack of blood flow (ischemia).
- Hemorrhagic stroke – bleeding into the brain or between the brain's membranes caused by the rupture of a blood vessel.
- Mini-stroke or transient ischemic attack – a brief episode of ischemia with symptoms lasting less than 1-2 hours.
A common architecture of a telestroke solution includes the following elements:
App for the emergency care team
– to initiate a real-time stroke consultation or a follow-up consultation with a vascular neurologist using videoconferencing technology, view a patient’s treatment plan, etc.
App for vascular neurologists
– to provide a real-time patient examination, stroke assessment and consultations, access and evaluate patients’ lab results, medical images, and health parameters, manage patient treatment and medication, etc.
Video streaming server
for real-time audiovisual communication between an emergency care team, a vascular neurologist, and a patient (can be developed from scratch by the neurological center’s development team/vendor or used according to the SaaS model).
Cloud data storage and processing module
for analyzing patients’ information (e.g., device-generated data, treatment plans), storing consultations’ recordings, etc.
Admin web panel
(for application administrators and health services managers) – to manage application access for the medical staff; to view and assign consultation requests, view the list of stroke patients and their records; to monitor and analyze the quality of services (connection, audio/video quality, stroke care consultations timings), etc.
EHR or EMR
– to enable a vascular neurologist to diagnose and treat the patient based on medical history, chronic conditions and allergies analysis. The patient’s medical and contact information from the originating site’s EHR should be automatically uploaded to the neurological center’s EHR for treatment, billing, etc.
Practice management system (PMS)
– to access the healthcare specialists’ schedules (of the neurological center and the originating site), automate billing, etc.
Medical imaging software and laboratory software (LIS)
– to enable a vascular neurologist to have an instant view of diagnostic images and lab test results to identify a stroke type, vessel blockage location, and decide on treatment prescription. Depending on the telestroke system functionality, the medical images (e.g., CT scans, MRI scans) can be transferred via API to the cloud server for image analysis or analyzed by the vascular neurologist via the DICOM viewer.
Connected hospital devices or sensors
– to provide a vascular neurologist and a care team with the real-time tracking of patient vitals for diagnosing and symptoms monitoring.
Gala Batsishcha, MD, Healthcare IT Consultant at ScienceSoft, shares insights:
"CMS-regulated payers (Medicare, Medicaid, etc.) reimburse services of both the originating site and the neurological center. To receive the reimbursement, both sites should log the stroke case in EHR with the billing codes according to CMS guidelines."
A patient rehabilitation module (optional):
App for patients
– to enable patients to schedule and have follow-up appointments with a neurologist, log their symptoms, follow in-app rehabilitation and treatment plan, have online rehabilitation sessions, etc. (depending on a patient’s condition after receiving stroke treatment, it can be operated by a patient’s relative or another caregiver).
Smart connected medical devices
(e.g., blood pressure monitor, ECG patch) – to automatically measure and collect patient’s vitals for further analysis.
When designing a unique feature set for a telestroke solution, ScienceSoft's healthcare IT consultants take into account customers' business needs and requirements. Here is the list of common features ScienceSoft implements:
Remote stroke care consulting for emergency centers
- 24/7 vascular neurologist consultation requesting by a remote emergency care team.
- Notifications on new telestroke requests for on-duty neurologists.
- Videoconferencing for emergency consultations with a vascular neurologist.
- Instant chat between an on-site care team and a vascular neurologist.
- Patient examination checklists for a vascular neurologist (visual assessment, evaluation of motor skills and speech).
- Follow-up patient examinations.
In-app stroke diagnostics and treatment assistance (advanced SaMD features)
- NIH stroke scale calculator to assess stroke severity based on patients’ reactions.
- Alberta Stroke Program Early CT Score (ASPECTS) calculator to determine stroke severity using available CT data.
- t-PA dose calculator to prescribe the thrombolytic drugs to patients with ischemia.
- AI-based CT scans analytics for automated stroke type diagnostics and abnormalities identification.
- Modified Rankin scale (mRS) calculator to measure the degree of stroke patients’ disability or dependence in daily activities (for recovery and rehabilitation monitoring).
Stroke treatment planning and coordination
- Electronic treatment plan creation (custom or template-based).
- A patient’s treatment plan export (e.g., for sharing with a rehabilitation provider).
- Real-time tracking of patient vitals with connected devices or sensors (for monitoring medication efficiency and stroke symptoms alleviation).
- Stroke treatment efficiency assessment, rehabilitation assignment (after a surgery or medication treatment).
Stroke patient data storage and access
- Stroke case details, follow-up visit details, and prescriptions.
- In-app access to a patient's medical history, medical images (e.g., MRI, CT, ECG scans) and lab results for a neurologist.
- Access to recordings of teleconsultations for an emergency care team and a vascular neurologist.
Data security and patient safety
- PHI access management (e.g., restricted editing of PHI, version history).
- Identity management and multi-factor authentication.
- Telestroke software data encryption (for video and audio calls, messages, patient records, etc.).
- HIPAA and HITECH compliance.
- FDA regulations compliance (for telestroke software with SaMD features).
Stroke care training
- Remote stroke care training for emergency care teams (e.g., about novel stroke therapies and their use).
- Remote supervision by an expert vascular neurologist for doctors providing acute stroke care.
For neurological centers
Service coverage expansion and increased capacity of treated patients.
- Reduced time from patient admission to stroke diagnostics and treatment (door-to-needle time) due to quick access to neurological care.
- Decreased risk of stroke-related complications and disabilities due to timely decisions about patient treatment. A study proves that relative rates of 30-day mortality of patients who received care at telestroke-enabled hospitals were 4% lower compared with patients who received care at hospitals without a telestroke program in place.
- Minimized patient transfer expenses and risks (for patients who need non-surgical treatment) due to faster care delivery backed up with expert consulting at the emergency department of a local hospital.
- Improved diagnostic accuracy in emergency care due to close collaboration with vascular neurologists.
Telestroke software success highly depends on its ability to provide timely care. ScienceSoft's consultants defined factors helping to ensure it with technology:
Clear UX – to make user journeys simple and save time of the medical staff involved in stroke care.
Seamless integration with required systems – to provide a vascular neurologist with an integrated patient view, timely access to all needed patient data via EHR, LIS, medical imaging software, etc., resulting in quality stroke care.
Example of Telemedicine for Stroke Care
- Massachusetts General Hospital (MGH) offers comprehensive telestroke and teleneurology programs to community hospitals. Now, over 95% of consultation requests are answered within five minutes. Clinicians in remote hospitals report that MGH neurologists’ consultations improve decision-making confidence and allow treating 71%-88% of telestroke patients locally.
ScienceSoft recommends you opting for custom telestroke software development if your healthcare organization needs:
- High convenience of telestroke requests creation and processing, as well as collaboration with partnering hospitals.
- Automated data processing for telestroke program administration, case reporting, and receiving reimbursement.
- Medical image analysis for automated identification of a vessel clot or rupture to ensure faster stroke diagnosis and treatment (may require FDA registration of the software).
- VR-based surgery planning using MRI or CT-based 3D modeling for patients needing endovascular treatment in the neurological center.
- Rehabilitation module (e.g., VR or telemedicine-based) and a patient rehabilitation application to facilitate recovery and decrease the risk of patient complications (e.g., thrombosis, limb contractures, bedsores).
ScienceSoft brings in 17-year experience in healthcare IT to implement telehealth software for emergency stroke care assistance.
Telesroke software consulting
- Analysis of your telestroke software needs.
- Suggestion of and elaboration of telestroke software features.
- High-level architecture design and tech stack selection for a telestroke solution.
- Telestroke software implementation plan.
- High-level integrations design (for EHR/EMR, LIS, medical imaging software, and more at the hospitals and at the neurological center).
- Knowledge transfer to the development team and consulting support throughout the implementation project.
Telestroke software implementation
- Telestroke software needs analysis and requirements elicitation.
- Telestroke features planning and prioritization.
- Software architecture design and selection of an appropriate tech stack.
- User journey mapping and UX design.
- UI design of the telestroke software.
- Development and testing of the software.
- User training for the stroke care teams and neurologists.
- After-launch telestroke software support (if required).
ScienceSoft's Customers Say
We engaged ScienceSoft to build an Android telehealth app that complements our web-based platform for our patients. They advised and successfully lead the way from end to end through the technical challenges and considerations with development of the app. We have also engaged them to introduce a few enhancements to the app and would certainly consider ScienceSoft as a technology partner in further software development initiatives.
Justin Turner, CTO, Chiron Health
ScienceSoft is an international IT consulting and software development vendor with 17 years of experience in healthcare IT. Being ISO 13485-certified to design and deliver medical software according to the requirements of the FDA and the Council of the European Union, ScienceSoft advises on the implementation of telehealth solutions for stroke care and develops software for rapid and accurate stroke diagnosis and treatment.