It was a short 21 years ago, in 1996, that stroke care was transformed. That was the year the FDA approved tPA. The new medicine revolutionized the approach to treating acute ischemic stroke.
But as Eric Anderson, MD, PhD, explained at the 2017 American Academy of Neurology Annual Meeting, it was also the tipping point for revolutionizing the use of tech in neurology.
Because of tPA, acute ischemic stroke became an emergency. Stroke patients needed to be seen within a 4.5-hour window to benefit from the new drug. This meant a trained neurologist needed to see the patient ASAP.
Unfortunately, small and rural hospitals did not always have neurologists available to evaluate patients for their suitability to receive tPA. In fact, ten years after its introduction, more than 60 percent of hospitals were still not using tPA.
Enter Telestroke. This technology allowed trained neurologists from Joint Commission-approved stroke centers to evaluate stroke patients remotely, improving outcomes for stroke patients even in the most remote locations.
And just as Telestroke arose naturally from the need to rapidly evaluate patients for tPA administration, other uses of this technology will naturally follow as we become more comfortable with it. The future offers unlimited opportunities to incorporate technology into practice.
The door is now open for other remote neurology functions such as EEG and ICU monitoring. Pre-hospital (ambulance) care is now possible. Checking in on nursing home patients or the chronically ill in their own homes is becoming more realistic.
Of all specialties, neurology has some of the most immobile patients. Telemedicine is particularly beneficial in this circumstance.
In addition to telemedicine, wearable tech is becoming more common and providing more and more information. In his talk, Dr. Anderson explained, that so far these devices provide data that physicians primarily react to. But over time the data collection may be used predictively across a number of disorders such as:
- Sleep disturbance in dementia patients,
- Gait issues for those with Parkinson Disease, or
- Activity monitoring for Multiple Sclerosis patients.
Despite the giant leap forward in use, there are still some limitations to employing technology in neurology practice. Primarily, any type of physical exam presents difficulty in using telemedicine, particularly if subtle findings are important such as in the case of neuromuscular disease.
For this reason, the American Academy of Family Physicians states that telemedicine care should be within the framework of longitudinal care for patients who have an established relationship with their provider. And the American Medical Association advocates for appropriate telemedicine training so that appropriate care is given and barriers to care are removed.
It was difficult to predict a short twenty years ago how Telestroke would transform stroke care. The experience with Telestroke has given neurologists a head start on understanding the benefits of tech in medical care. How will technology transform neurology in the next 20 years? It’s difficult to say for sure, but as Dr. Anderson points out, “The best way to predict the future is to create it.”