44 southernoregonmagazine.com • fall 2012 A t 5:30 a.m. one morning last spring, Lavetta Murray woke up knowing something wasn’t right—that she wasn’t right. She was disoriented and losing her ability to control her movements and thoughts, so she immediately telephoned her daughter, Tamara Shults. Shults called 911, believing her mother’s symptoms indicated a stroke. e ambulance team took Murray from her home in Gold Hill to Providence Medford Medical Center. Shults followed and watched helplessly as the emergency room personnel quickly took over her mother’s care. ey reassured her that a specialist would be coming in to assess her mother. “No one said he was going to be a robot,” Shults remembers. “When it rolled in, I was blown away. I’d never seen anything like it. It was pretty astounding. It’s like you’re in a sci-fi movie.” MOBILE TELEMEDICINE Telemedicine is the diagnosis and treatment of patients via telecommunications technol- ogy. It isn’t especially new. In various forms, physicians have been utilizing telemedicine for many years. Now, though, it is mobile and wireless. Rather than appearing via video conferencing at a fixed time and place, a specialist in another city can now be called directly to the patient’s bedside to examine and interact with the patient, family and local ER professionals through a mobile robot. And he teLemedicine opens new tReatment options woRds by Cheryl Rose photogRaphy pRoVided by Providence Medford Medical Center The Robot is on a Roll the good Life Health or she can do all this from a laptop, or, in coming months, an iPad. ink super-advanced FaceTime or Skype. STROKE RESPONSE TIME ough telemedicine has many applications, one of the most dramatic is the assessment of stroke victims, allowing for rapid intervention. “ere are very few medical diagnoses that come down to a few hours, but stroke is one of them,” explains Dr. Cory Bergey, the medical direc- tor for Providence Medford Medical Center Emergency Services, the first location to go live with this technology in the Rogue Valley in 2010. “With most conditions, you don’t forfeit a treatment if it’s an extra hour, but this is one where every single minute is important.” A stroke happens when blood flow to part of the brain is stopped. For every minute the brain is deprived of oxygen, two million brain cells die. Ischemic strokes—caused by an obstruction, such as a clot in a blood vessel—account for nearly 90 percent of stroke cases. ere is a clot-busting drug called tPA (Tissue Plasminogen Activator) that, if given within four hours of stroke symptoms, can significantly improve outcomes. However, it is a dangerous drug if given outside the time limit or for anything other than the right type of stroke, so doctors have to be very certain of the diagnosis. “e telemedicine support is paramount for me when making this important decision where a patient can hemorrhage and speed is so critical,” Bergey says. “ere are very subtle symptoms a stroke neu- rologist is trained to recognize that might be missed if we didn’t have this system.” dr. nicholas okon, the medical leader for the providence telestroke network.
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44 southernoregonmagazine.com • fall 2012 fall 2012 • southernoregonmagazine.com 45
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At 5:30 a.m. one morning last spring, Lavetta Murray woke up knowing something wasn’t right—that she wasn’t right. She was disoriented and losing her ability to control her movements and thoughts, so she immediately telephoned
her daughter, Tamara Shults.
Shults called 911, believing her mother’s symptoms indicated a stroke. The ambulance team took Murray from her home in Gold Hill to Providence Medford Medical Center. Shults followed and watched helplessly as the emergency room personnel quickly took over her mother’s care. They reassured her that a specialist would be coming in to assess her mother.
“No one said he was going to be a robot,” Shults remembers. “When it rolled in, I was blown away. I’d never seen anything like it. It was
pretty astounding. It’s like you’re in a sci-fi movie.”
MOBILE TELEMEDIcInE
Telemedicine is the diagnosis and treatment of patients via telecommunications technol-ogy. It isn’t especially new. In various forms, physicians have been utilizing telemedicine for many years. Now, though, it is mobile and wireless. Rather than appearing via video conferencing at a fixed time and place, a specialist in another city can now be called
directly to the patient’s bedside to examine and interact with the patient, family and local ER professionals through a mobile robot. And he
teLemedicine opens new tReatment options
woRds by cheryl Rose
photogRaphy pRoVided by Providence Medford Medical center
The Robot is on a Roll
the good Life Health
or she can do all this from a laptop, or, in coming months, an iPad. Think super-advanced FaceTime or Skype.
STROkE RESPOnSE TIME
Though telemedicine has many applications, one of the most dramatic is the assessment of stroke victims, allowing for rapid intervention.
“There are very few medical diagnoses that come down to a few hours, but stroke is one of them,” explains Dr. Cory Bergey, the medical direc-tor for Providence Medford Medical Center Emergency Services, the first location to go live with this technology in the Rogue Valley in 2010. “With most conditions, you don’t forfeit a treatment if it’s an extra hour, but this is one where every single minute is important.”
A stroke happens when blood flow to part of the brain is stopped. For every minute the brain is deprived of oxygen, two million brain cells die. Ischemic strokes—caused by an obstruction, such as a clot in a blood vessel—account for nearly 90 percent of stroke cases. There is a clot-busting drug called tPA (Tissue Plasminogen Activator) that, if given within four hours of stroke symptoms, can significantly improve outcomes. However, it is a dangerous drug if given outside the time limit or for anything other than the right type of stroke, so doctors have to be very certain of the diagnosis.
“The telemedicine support is paramount for me when making this important decision where a patient can hemorrhage and speed is so critical,” Bergey says. “There are very subtle symptoms a stroke neu-rologist is trained to recognize that might be missed if we didn’t have this system.”
dr. nicholas okon, the medical leader for the providence telestroke network.
46 southernoregonmagazine.com • fall 2012 fall 2012 • southernoregonmagazine.com 47
the good Life Health
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Since implementing the Providence Telestroke Network, Providence Medford Medical Center has increased the use of tPA by 90 percent.
TELESTROkE nETWORk
In the emergency room, Murray was con-scious, though disoriented. “The robot came over to the bed and talked to me and it seemed so weird, I kind of thought I was dreaming, but it was marvelous what he did,” she says.
The Providence Telestroke Network is a group of stroke-specialist neurologists at the Providence Brain Institute in Portland who are on call for emergency stroke intervention at 16 locations throughout Oregon. In less than ten minutes of an alert, the telestroke physician can beam into the video screen of a robot in Medford and actually drive that robot to the patient’s bedside. Shults describes the interaction with the virtual doctor as sur-prisingly normal, as if he was in the room with them instead of miles away.
Dr. Nicholas Okon, the medical leader for the Providence Telestroke Network, helped launch the telestroke effort in Oregon. “It’s spread like wildfire because ER docs love hav-ing this service and patients love the idea of having a specialist by the bedside, especially when time is critical,” he says. “Patients are very receptive and thankful.”
specialist physicians, the Rogue Valley is not a remote location. In fact, Providence Medford Medical Center has three local neurologists affiliated with the hospital. So why use this technology here?
“Why it continues to grow is that once you see the difference in the intervention time and the patient being discharged to go home rather than to a skilled nursing facility, that makes you a believer,” Bergey says.
Even Providence hospitals in Portland are using the telestroke network because of how quickly a specialist can intervene, rather than the typical scenario where he or she must be paged, respond and then drive in to the hospi-tal—a delay that could mean missing the win-dow for tPA use. “It’s just been fabulous that within five minutes I have an expert in stroke medicine right there with me to discuss the case,” Bergey says. “Our local neurologists do a great job and are still very important. This is just a way to do everything faster in an acute situation.”
Bergey estimates that the Providence ER sees 30 to 40 possible stroke cases a month, with eight to ten of those proving to be treatable strokes. Okon says his group is fielding four to five calls a day, 85 percent of which prove to be actual strokes. “Telestroke is becoming the most common telemedicine application,” Okon says. “There is such a shortage of stroke neurologists and the need is so high that it’s popping up throughout U.S.”
IMPROVED OuTcOME
Murray’s stroke occurred in May and she received tPA based on the telestroke neurolo-gist’s assessment during her critical period. She went home from the hospital and has had rehabilitation therapy throughout the sum-mer. Though her right arm remains paralyzed, she has gotten some finger movement back. “The shot they gave me—I think it made the stroke less severe,” Murray says. “I’m talking pretty good, my thinking ability seems okay, I’m able to dress myself and I’m able to come home. I feel that shot saved a lot of major damage.”
For Shults, it’s simple. “They saved her life.”
Providence Telestroke Network
Providence Stroke Center, part of Providence Brain and Spine Institute, is a nationally certified primary stroke center and a leader in comprehensive, state-of-the-art stroke care, education and research. Providence St. Vincent Medical Center and Providence Portland Medical Center are both Get With The Guidelines® gold award recipients for consistent excellence in stroke care.
PortlandProvidence Portland
Medical CenterProvidence St. Vincent
Medical CenterProvidence Hood River
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Medical Center
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Pioneer MemorialHospital – Heppner
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Miles away … and by your sideWhen it comes to stroke, time is brain. The faster patients can be diagnosed and treated, the better their outcomes. This can be a challenge in small or rural communities where 24-hour access to stroke specialists is rare. Thanks to novel new technology, neurologists from Providence Brain and Spine Institute in Portland can now be “in the room” with patients who are hundreds of miles away.
Through a secure two-way videoconferencing system, a Providence neurologist can review patient records and diagnostic results, perform a full examination and consult with local clinicians to help determine the best and fastest course of treatment.
To learn how Providence Telestroke Network works, call us at 503-216-1055 or visit www.providence.org/OregonTelestroke.
Around the clock, around the region, our stroke specialists are with you when every minute counts.
Bergey confirmed that local patients are ready to accept the unusual if it means access to a top specialist. “I’ve never had a single concern expressed from a patient or family.”
IMPAcT
While the positive impact of telemedicine is easily seen for rural communities without
48 southernoregonmagazine.com • fall 2012 fall 2012 • southernoregonmagazine.com 49
the good Life Health
V. Virtual
I . Interactive
n . Neurologic
c . Consultation
E. Equipment
V.I.N.C.E. sits quietly plugged into a wall recess in the emergency room. When an alert comes, a stroke neurolo-gist in Portland can activate V.I.N.C.E. and via remote control, steer it down the hallway to a patient’s room. Visible on the video screen in Medford, the tel-estroke doctor is able to turn the robot’s head 360 degrees. The physician can zoom in to examine a patient’s pupil, or with a nurse’s assistance, listen through the robot’s built-in stethoscope to the patient’s heartbeat.
“Beaming in on the robot is very similar to walking into a consult,” Okon says. “The technology is fluid in both the video and audio communication, with the ability to zoom in to read monitors or turn and talk to a family member.”
Providence leases the robots from In Touch Health in San Diego, California. In Touch monitors the robots’ main-tenance. The robots have a battery life of six hours. Each robot has a different name, christened by its local hospital team.
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