Reaching for the cloud: telestroke

A truly unique telehealth program promises to link the nation’s
health workforce like never before.

The Australian Stroke Alliance plans to build upon the telestroke model that has been successful in Victoria, creating Australia’s first national digital telestroke network.

The earlier we treat a stroke, the better the outcome. In Victoria, patients in rural and remote communities have been able to access early stroke care through the Victorian Stroke Telemedicine program, coordinated through Ambulance Victoria. It has successfully supported regional stroke treatment, on a small scale, with 17 regional hospitals in Victoria and two in Tasmania. They are linked with emergency services and stroke specialists in metropolitan Melbourne. This has improved the quality of stroke care and enabled thrombolysis to be given earlier and more safely.

"It is always frustrating seeing patients who have lost their ability to walk or speak after a stroke. But this is worse when you know that they could not receive treatment just because they lived remotely. Stroke treatment should not depend on the place where you live."

- Dr Alvaro Cervera, neurologist, Royal Darwin Hospital

The wider application of the telestroke model is limited by old technologies and piecemeal implementation. Currently, each state implements patchwork telestroke models which do not include all regions and where each network uses a different set of protocols to make treatment decisions based on different minimum clinical data. Patient follow-up is rarely performed, leaving a critical gap in the monitoring of patient outcome. This is particularly important because the most significant risk factor for having a stroke is having previously had a stroke (10 per cent in the first three months after stroke and 6 per cent every year after).

The Alliance’s telehealth platform

  • Addresses the growing disparity in stroke outcomes for rural, remote and Indigenous communities
  • Offers real time assessment for stroke intervention in remote locations, supporting rural practitioners in diagnosis and treatment
  • Implements a nationally coordinated stroke telemedicine network to overcome various limited services.

As well, it will:

  • Build on the highly successful Victorian Stroke Telemedicine Service which has delivered safe thrombolysis for seven years
  • Work with all states and territories to offer a national, digital system. Currently Tasmania, NSW, WA and QLD are developing versions of the Victorian program, emphasising the need for a national approach
  • Adapt to different geographies responding to the need for tailored approaches to telehealth. We know that one size does not fit all
  • Design telestroke models to meet the specific needs of regional Indigenous Australians who have a 3-fold rate of acute ischemic stroke and mortality compared to non-Indigenous Australians.

A truly national network

The Alliance will create three important links: to local ambulance services in all states and territories, to patients’ electronic patient records and to a data hub for optimisation modelling. This will be a world-first for mobile pre-hospital stroke care, enabling not just more effective and efficient care but it will underpin long-term optimisation of emergency health resource deployment across our vast country.

"Telemedicine services are now operating in limited areas, but more investment is required to develop a nationally coordinated stroke telemedicine network."

- No Postcode Untouched report: Stroke Foundation (2017)

There’s an app for that

Scaling up telestroke capability to reach all of Australia demands a new and digital approach. A cloud-based system with links to regional hubs and customised app-based tools will be used in the field. This will finally enable frontline GPs, paramedics and nurses at the scene of a remote stroke to receive an unprecedented level of support through seamless videoconferencing with a roster of stroke physicians 24-hours a day.

A new level of care will be delivered using a suite of tools enabling clinical dialogue – including AI-driven automation. Simplified and easy to interpret images will be produced for rapid assessment. Stroke physicians will be given enough information to advise on the appropriate treatment at the scene.

We know it will work because we have piloted a cloud-based model of telestroke on Australia’s first stroke road ambulance in Melbourne. We have developed a mobile app that transmits crucial clinical data and brain images, as well as audio-visuals of the patient from the vehicle to stroke specialists who advise from other locations around the country.

We are ready to adapt the app so it works in a range of space-constrained environments like a helicopter or rural road ambulance, supporting doctors, paramedics and nurses as never before.

These developments will lay the foundations for a digital ecosystem, ready for our novel mobile stroke units to plug in when launched across the country. This will link remote air and road stroke ambulances to city-based medical specialists and electronic patient records – and a data hub for optimisation modelling.

This is a real-time solution for remote Australians who have, until now, been overlooked.

Follow-up care

The app-based approach incorporates a patient-driven follow-up tool to connect stroke survivors with post-stroke support. This is especially important as we co-develop customised tools, in partnership with Indigenous communities, to enable On Country care.

A resilient and consumer-responsive workforce

The Alliance is committed to developing optimisation modelling tools to predict the nation’s requirements for ground-breaking pre-hospital resource allocation. For the first time, digital modelling will help build a policy framework that achieves demand-responsive and cost-effective allocation of health resources across the nation.

Not only is this an initiative that will address inequity of access, there is a powerful economic incentive to reduce the number of rural and remote Australians who are left with long-term, significant disabilities from stroke.

Together with the nation’s ambulance partners, including the Royal Flying Doctor Service, we will develop a platform to model and test resource allocation of our novel road and air stroke units in test beds across Australia. This will provide a much-needed sustainable resource for optimisation, long-term.

"We will identify the barriers so we offer the right treatment, at the right time, for the right patient"

- Neurologist and co-chief investigator, Professor Stephen Davis

Meet telehealth neurologist, Chris Bladin.

Meet one of the Alliance’s telestroke architects, Andrew Bivard.

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