Mayo Clinic Telestroke Program

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A recent agreement between Tuba City Regional Health Care and Mayo Clinic in Arizona will bring state-of-the-art stroke care to Navajo and Hopi patients through telemedicine. Dr. Bert Vargas, a Mayo Clinic telestroke neurologist, will talk about the new program, set to start in November.

Ted Simons: Here to tell us more about the program is Dr. Bert Vargas a Mayo Telestroke neurologist. Thanks for joining us. We were just talking about this. You have twelve partners now, as far as telemedicine is concerned but they are all a little different aren't they.
Bert Vargas: That's absolutely true. It's really interesting as you start working with different populations even though the way we manage these situations is going to be very similar, as you deal with different populations you deal with different medical issues that come up. Then there's of course different sensitivities and social issues that you have to be aware of as well.
Ted Simons: So tuba city regional head care is the latest partner. How did the agreement develop? What exactly is being done? Describe telemedicine for us.
Bert Vargas: I would love to. It really starts off with the fact that stroke, which is what we'll start off discussing, is the third leading cause of death in the United States. Leading cause of disability. 800,000 strokes every year. What the problem that we face is that 40% of the population lives in a County that's outside of the area of a hospital that's really engaged in stroke care. So what we have looked to do is to provide that level of expertise, telemedically so through our audio visual cameras cameras and our telemedicine carts we're able to assess stroke patients when they come into a rural emergency department and give them what is really the standard of care in a major metropolitan area.
Ted Simons: What kind of assessments can be done? Can you do a brain scan? Can you look at a brain scan and figure things out from that angle?
Bert Vargas: It's amazing what we can do these days. We can not only have a face-to-face conversation with the patient and the patient's family, but we have access to all of their laboratory data and what's maybe one of the more exciting developments is just as you mentioned we can look at a brain scan not only on our remote laptops but even now we have been able to show that we can use smart phones and that's actually more than sufficient to be able to make a decision whether we should be giving a patient a clot-busting medication like TPA when they have a stroke.
Ted Simons: And time really is so important when it comes to stroke treatment, isn't it?
Bert Vargas: Time is key. For a while we were looking at a three hour time frame and still that's a benchmark that we really look at as a general guideline. In some populations we can extend that window out a little bit to four and a half hours. But really time is brain. We always try to emphasize that to people, that when they have signs or symptoms of a stroke that they come into an emergency department immediately for evaluation.
Ted Simons: When they do, obviously we saw patients -- a patient is there and there is a screen and there is a doctor basically giving instructions, advice and assessment. That's really something. Amazing.
Bert Vargas: It really is. In many instances it's just like being there. Just like being in the room, we have the ability to pan, tilt, zoom, turn around and talk to other people in the room, and even when the patient is outside of the room it's like having a conversation with their family.
Ted Simons: What kind of challenges do you see as far as assessing patients in this way and treating patients in this way? Because it looks great but I'm sure there are speed bumps along that little machine's path.
Bert Vargas: Right. Well, I think that the challenges that we face are so tiny compared to the benefit, and really I can probably summarize them just in the novelty of the technology I think may surprise some people. So I have certainly been on the other ends of the camera when one of our telemedicine robots comes into the room and the patient lying in the bed just looks very surprised that they have a camera screen with our image on it but on a nonhuman body. So that may be one of the biggest barriers.
Ted Simons: Let me ask you this, though. I would think for some patients they might be less willing to open up to someone on a screen, but you might get even more from a patient talking to a screen as opposed to a human being in the room. Have you found that?
Bert Vargas: Well, I found that as the interaction goes on, and as our patients see that we're comfortable with the technology, just as we're talking right here, we have that conversation, and it just flows so naturally that in many instances they don't even remember that they are talking to someone that's 200 miles away.
Ted Simons: Yeah. What about cost? Who pays for what?
Bert Vargas: Well, that's a great question. That's one thing that we're constantly trying to address and constantly trying make more cost effective for people. Just as it is right now, we have agreements and we have subscriptions with as you've mentioned 12 emergency departments, and they help cover the costs so that not only their patients are getting the care they need but also so that they can stay in their communities. If you can think about before telemedicine, they would send a lot of these patients to larger metropolitan areas. They would be taken away from their communities, from their families. And now they can get that care locally and most of them stay in that area. So in that respect it's very cost effective and when we actually tabulate the over-all costs over a lifetime, taking into account the number of years that they continue to live and taking into account the degree of disability we're able to prevent, it ends up being an incredibly cost effective option for many emergency departments.
Ted Simons: What you mentioned first of all -- less in the way of ground transport, air transport. That costs as well, and I would imagine that's been cut down dramatically in some of these rural areas.
Bert Vargas: Oh, absolutely. We at the present time only find the need to transfer patients less than a third of the time. Less than 30% ends up being transferred to a larger center.
Ted Simons: Tuba City program set to start next month sometime?
Bert Vargas: Yes. We'll be starting that up and they will be joining -- joining our larger network of Telestroke programs and in about half of our sites we also offer general neurology consultations, so we're really expanding our reach and expanding the type of service that we're providing these communities.
Ted Simons: I would imagine, although I'm not sure, I would imagine doctors in these rural areas are very glad to get this kind of consultation, but do you get every once in a while someone a little reticent to share information, no, I can handle it we don't need this kind of thing?
Bert Vargas: On the contrary, about 90% of emergency room physicians seem very interested, excited, engaged in using this technology because I think they see that there has been a benefit. A proven benefit not only in outcomes and making sure that their patients are getting the care they need, but also in cost. When you put those together, I think they realize that it's really the best option for the patient.
Ted Simons: Certainly sounds as much. Good to have you here. Thanks for explaining it to us and continued success.
Bert Vargas: Thank you so much for having me.

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