Momentum telemedicine service descriptions

Xarxa TeleIctus (ES)

Objectives, expected outcomes, main beneficiaries

Xarxa TeleIctus, or “Tele-Ictus Network” (“ictus” is Catalan for “stroke”), is a telemedicine service that facilitates specialised/tertiary attention to stroke patients within the first hours of the incident. It covers the Catalonia region according to the criteria and requirements of the Directors’ Plan for Circulatory System Illnesses/Cerebral Vascular Illnesses of the Catalan Health Department.

Stroke is the second cause of death worldwide and the main cause of disability in industrialised countries. For a stroke patient’s survival, one of the most critical factors is response time.

By deploying the Tele-Ictus Network the goal is to reduce response time in stroke diagnoses in Catalonia, and therefore also the consequences of stroke.

The goal of the service is to enable expert neurologists specialised in strokes, who are on duty and located in a reference hospital, to diagnose stroke right from the moment the patient arrives at the emergency service of a regional hospital and to support emergency service professionals via videoconference.

AIAQS measured the improvement of quality of care in cardiovascular disease and stroke treatment through telemedicine.

Targeted population, number of patients

The target population includes patients undergoing specific treatment/acute/emergency intervention. More specifically, the global population is patients with stroke symptoms that have being diagnosed at a regional local hospital.

Between 50 to 100 people receive the service each month (there were approximately 600 consultations during 2010).

Type of telemedicine service

The service is categorised as a diagnostics service. The relationship between key actors in the service is primary care to secondary care.

Set-up that was being replaced

The telemedicine teleconsultation replaces physical transports where patients with stroke symptoms are sent by ambulance from the local area hospital to a reference hospital where the appropriate expert/s are located. The journey takes usually longer than 145 minutes, and causes delays in diagnosis and treatment.

Outcomes and results expected after introduction

The main expected outcomes relate to the quality of care, cost-effectiveness, and general results.

Quality of care: The main evidence of quality of care improvement is the fact that a patient has a diagnosis, and is treated with thrombolytics by a stroke expert before the critical time-period of 180 minutes is exhausted.

Cost-effectiveness: No long-distance transportation is needed. Costs for emergency admissions and professionals’ fees in regional hospitals are reduced or avoided.

Results: Fifty-five per cent of the strokes treated in Vall d’Hebron reference hospital, and others, come via Tele-Ictus. This has amounted to approximately 600 consultations being undertaken during 2010.

Detailed description

The treatment follows a specific established protocol, namely the stroke protocol for adequate treatment.

The service platform is proprietary: it is called “Medting”. Medting is a web application for publishing, sharing and checking all kinds of clinical applications. First the image captured at any of the local centres is uploaded with MIO LT into the Medting platform. With MIO LT, it is possible to share and access any medical image in a totally centralised way, even from outside a radiological environment. This is done by intense use of medical standards (such as CDA, HL7, and DICOM).

Subsystems include:

• Videoconferencing – Allows the neurologist to have a detailed analysis of the external symptoms of the patient.
• Image transmission – Allows DICOM images that come from a cerebral computerised tomography (CT) scan directly to be sent to an online repository that the reference hospital neurologist can consult.

The hospital requirements include:

• Unique speaker identification
• Stroke registry
• Ambulance service SEM nominated, available and with medical units
• >100 strokes/year
• Being approximately 40 km from the reference centre/reference hospital
• Having 24-hour CT cranial availability
• Emergency lab available 24 hours
• Rehabilitation unit continuously available
• Hospital stroke protocols available with treatment capacity
• Intensive monitoring unit at the regional hospital.

The communication system operates between hospitals. Specific IT requirements include:

• Public Internet Protocol (IP), firewalls, and more than 1 Mbps.
• Connectivity: This is a physical LAN from an emergency box.
• Sending the CT images in DICOM format to the repository.
• It is necessary to add an intermediate computer which receives DICOM and encapsulates in HTTP.
• There is an etiologic diagnosis and agreement among stakeholders.

The parties involved are the teams in the reference hospital, a local (regional) hospital, and a patient.

Operational status

The service is operational and part of mainstream healthcare service.