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© 2015 Arizona Telemedicine Program
Clinical ApplicationsRonald S. Weinstein, M.D.
Director, Arizona Telemedicine Program
© 2015 Arizona Telemedicine Program
• Success factors• Barriers
• Success factors• Barriers to success
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© 2015 Arizona Telemedicine Program
1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
Tele-urgent Services
© 2015 Arizona Telemedicine Program
1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
Tele-urgent Services
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© 2015 Arizona Telemedicine Program
Teleradiology – 1,300,000+ cases
© 2015 Arizona Telemedicine Program
1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
Tele-urgent Services
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© 2015 Arizona Telemedicine Program
Tele-Neonatal Intensive Care ServicesYuma Regional Medical Center – UMC, Tucson
Yuma, Arizona – Tucson, Arizona
© 2015 Arizona Telemedicine Program
1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
Tele-urgent Services
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© 2015 Arizona Telemedicine Program
Telepathology
© 2015 Arizona Telemedicine Program
Tele-urgent Services 1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
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© 2015 Arizona Telemedicine Program
1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
Tele-urgent Services
Emergency Medicine – Banner HealthCourtesy, Debbie Dahl, EE
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eCareMobile
Correctional Facility
ClinicseED
Stroke Neurologist
Trauma Surgeon
Nephrologist
Psychiatrist
Initiate TX asap
ED
Referring sites
Tele-stroke
Trauma triage
Tele-psychiatry
Specialty call coverage
Intensivist & Hopstialist
ED
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Courtesy of Debbie Dahl, R.N.Banner Health
iCare BGMC MedSurg LOS
0
1
2
3
4
5
medical surgical
Average LOS (days)
0%
5%
10%
15%
20%
25%
medical surgical
LOS outliers (%)
Pre (2008) Post (2010)
Courtesy of Debbie Dahl, R.N.Banner Health
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© 2015 Arizona Telemedicine Program
Tele-urgent Services 1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
Teletrauma
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© 2015 Arizona Telemedicine Program
Tele-urgent Services 1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
© 2015 Arizona Telemedicine Program
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© 2015 Arizona Telemedicine Program
Background and Purpose• ResolutionMD mobile application runs on a Smartphone and affords vascular neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation.
• Although reliability studies using this technology have been conducted in a controlled environment, this study is the first to incorporate it into a real‐world hub and spoke telestroke network.
• The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular neurologists using ResolutionMD, spoke radiologists using a Picture Archiving and Communications System, and independent adjudicators.
© 2015 Arizona Telemedicine Program
Stroke. 2012; 43:3271‐3277
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© 2015 Arizona Telemedicine Program
Stroke 2012: 43; 3095‐3097
Photograph depicting the bedside National Institutes of Health Stroke Scale (NIHSS) assessment scenario.
Demaerschalk B M et al. Stroke 2012;43:3271-3277
Copyright © American Heart Association
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© 2015 Arizona Telemedicine Program© 2014, Arizona Telemedicine Program
© 2015 Arizona Telemedicine Program
Commercialization
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© 2015 Arizona Telemedicine Program
ResolutionMD mobile infrastructure and algorithm.
Demaerschalk B M et al. Stroke 2012;43:3098-3101
Copyright © American Heart Association
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ResolutionMD mobile.
Demaerschalk B M et al. Stroke 2012;43:3098-3101
© 2015 Arizona Telemedicine Program
Conclusions• Telestroke is cost‐effective (cost‐savings)
• Telestroke by smartphone is possible
Demaerschalk B M et al. Stroke 2012;43:3271-3277
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© 2015 Arizona Telemedicine Program
Tele-urgent Services 1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
© 2015 Arizona Telemedicine Program
Arizona Telemedicine Burn & Disaster Program• Courtesy of
• John & Lynn Schaper
• Maricopa Regional Medical Center
• Phoenix, Arizona
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© 2015 Arizona Telemedicine Program
Arizona Burn Center• Only Nationally Verified Burn Center in Arizona
• 45 Burn Beds – total 19 ICU Beds
• Surge Capacity of 30 Burn Patients
• 2nd Largest Burn Center (by volume) in U.S.
• Telemedicine “Hub” for Burn/Disaster.
• Telemedicine available 24/7
Courtesy of John and Lynn Schaper
AZ Burn Center’s Cart
Courtesy of John and Lynn Schaper
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Burn Center Nurses’ Station
Courtesy of John and Lynn Schaper
© 2015 Arizona Telemedicine Program
Vigilant Guard State Drill• 11 Hospitals using Telemedicine at various times.
• Every hospital successfully connected, some several times.
• Three separate pieces of telemedicine equipment used simultaneously.
• Multiple patients seen
• Dr. had far‐end camera control
Courtesy of John and Lynn Schaper
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© 2015 Arizona Telemedicine Program
Collaborative• ADHS
• ATP
• MIHS
• Arizona Burn Center
• All the participating hospitals and their emergency coordinators.
Courtesy of John and Lynn Schaper
© 2015 Arizona Telemedicine Program
Tele-urgent Services 1. Teleradiology
2. Telecardiology
3. Telepathology
4. Telepsychiatry
5. eICU (e‐Intensive Care Unit)
6. Teletrauma
7. Telestroke
8. Teleburn
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© 2015 Arizona Telemedicine Program
© 2015 Arizona Telemedicine Program
Thank you!
Ronald S. Weinstein, [email protected]
