Telemedicine: A Q&A with The Mayo Clinic’s Bart Demaerschalk, M.D. (Part 1)

Telemedicine in Arizona has a long history. AZHHA recently sat down with The Mayo Clinic’s Bart Demaerschalk, M.D., Medical Director for Synchronous Services, Center for Connected Care, which partners with hospitals across Arizona to provide the highest quality care for patients via telemedicine, and in particular, telestroke. This is the first of a two-part blog.

AZHHA: Why did The Mayo Clinic implement a telemedicine program?

Dr. Demaerschalk: Telemedicine in Arizona has been present for far longer than the telestroke program.  I initiated the program in AZ 10 years ago. Dr. Ben Babro, a former emergency medicine physician and colleague who also worked at Mayo, and I both have an interest in vascular disease, acute stroke, and out of hospital cardiac arrest. We recognized that outside the major metropolitan areas, patients were often transferred to a metropolitan cardiac or neurological center which took many hours. We strongly believed that our state could do better. As it went, we did some initial inquiries and there was not a program in Arizona. Neither of us knew a single thing about telemedicine but we strongly believed that someone needed to do something.

AZHHA: So, what did you do?

Dr. Demaerschalk: We applied to the Department of Health Services for a research grant and were awarded funds to start a clinical trial. We proceeded with a clinical trial called the STRokEDOC (Stroke Team Remote Evaluation Using a Digital Observation Camera in Arizona). In this trial, patients presented at Kingman Regional Medical Center and Yuma Regional Medical Center were randomly assigned to either a phone consult or a full audio/video consultation. We learned that patients with stroke syndromes who received video consultation got a more accurate diagnosis of stroke and more correct emergency treatment provision on site than those patients who only had access to the phone consult.

After a year, we reapplied to expand the concept to remote and rural hospitals. This program was called STARR (Stroke Telemedicine for Arizona Rural Residents). That resulted in a gradual expansion to a network of hospitals that did not have access to round the clock neurological care. We served hospitals in the south including Bisbee, Douglas, Yuma, Casa Grande, Maricopa (in Phoenix), Parker, Kingman, Sedona, Cottonwood, Flagstaff, Show Low, Globe and Tuba City. We provided, at a moment’s notice, an audio/video consultation.

AZHHA: How accurate is telemedicine?

Dr. Demaerschalk: Very. We compared the outcomes of virtual treatment vs. Mayo Clinic stroke centers and there was no difference in morbidity and mortality, that is, illness and death. The care was equivalent. Subsequently, it’s become the gold standard nationally. American Heart Association says that telestroke is the gold standard in hospitals that don’t have standard neurological teams around the clock. Telestroke has 98 percent accuracy of diagnosis and 98 percent correct decision making.

AZHHA: What were the results?

Dr. Demaerschalk: The results were excellent! There were huge cost savings compared to usual care, in which a patient would arrive, might have a phone call and then be transferred to a neurological center many hours away. Transport alone is expensive. If they arrived too late, they would end up with a permanent neurological deficit. They would be put into a rehabilitation center or nursing home, would be robbed of a high quality of life, and have a very expensive course of care.

AZHHA: What does the future of telemedicine look like?

Dr. Demaerschalk: There are so many innovations coming, and some that are already here. Artificial Intelligence will be key. I suspect that we will increasingly see artificial intelligence in healthcare as a complement (not a replacement) to the good work that healthcare providers provide for their patients.

Patients will demand telemedicine and other virtual medicine. Consumers have become accustomed to having access in all of the other facets of their lives and will demand the same in healthcare. IT will be stronger and more compelling, and this will empower [patients] to access their healthcare, use healthcare more efficiently, lower cost and, most importantly, take charge of their own healthcare.

In the future, I firmly believe that physicians won’t regard [telemedicine] as anything different. They won’t speak about telemedicine, they’ll just speak about medicine and about their clinical care. Almost certainly their clinical practice will include “digital care”. The practitioner of the future will seamlessly go from in person to communicating asynchronously or synchronously through technology, this will be the new norm.


DR

Bart Demaerschalk, M.D., is a specialist in Neurology and the Medical Director for Synchronous Services, Center for Connected Care.

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