Frequently Asked Questions
The neurologist usually drives in to see the patient. Isn’t that better?
How is REACH Call different than other telestroke solutions?
What are the other benefits of REACH Call?
Can we do more than just telestroke with REACHCall?
What technology is needed to perform the consult?
How much typing do I have to do during the consult?
How does the hub hospital get paid?
Does the neurologist have to be credentialed at the spoke hospitals?
Who makes the decision to give tPA?
Who makes the decision to transfer (or not transfer) the patient?
Can the spoke check for contraindication and warnings?
Who developed REACH and why?
REACH was designed by Dr. David C. Hess, Professor and Chairman of Neurology at the Medical College of Georgia (MCG), and other MCG physicians in Augusta, Georgia including Dr. Hartmut Gross, Dr. Robert Adams, Dr. Fenwick Nichols, Dr. Sam Wang, Dr. Chris Hall, Dr. Sung Lee, David Ramsingh, and Bill Hamilton. Deep in the heart of the stroke belt of the United States, rural hospitals in Georgia were unable to provide stroke care to patients who were visiting their ERs because they had no neurologist on staff. These stroke patients were transferred to MCG for treatment, often too late to receive tPA. With REACH, the physicians at MCG removed this rural penalty for stroke patients, and accelerated both patient assessment and treatment times.
How does REACH Work?
REACH typically is used in a "Hub and Spoke" network of hospitals, where the Hub Hospital provides physician-consulting services to Spoke Hospitals for remote evaluation of acute medical conditions such as stroke.
Several Spokes are connected to the Hub and leverage the expertise of physicians at the Hub to provide critical care for patients in their own ERs. These Spokes use a REACH cart to initiate a consultation request with a physician affiliated with a Hub. The cart is an assembly of non-proprietary, off-the-shelf components including a laptop, LCD monitor, keyboard, mouse, and a camera. The cart is battery-powered and is equipped with a wireless bridge for maximum mobility within an ED. Spoke Hospital ED staff can use the web browser running on the laptop embedded in the cart to register a patient and request a consult with a remote physician affiliated with the Hub.
Since REACH is a 100 percent web-based turnkey service, there is no hardware or software installed in the Hub Hospital. The consulting physician can use any laptop or PC, a standard, off-the-shelf web cam, and a broadband internet connection to communicate with the Spoke and evaluate the patient. The physician has complete control over the two-way audio and video communication and can view all patient data and DICOM images, such as CT Scans, and then use the integrated decision support tools to efficiently and effectively evaluate the patient and recommend treatment.
Why telemedicine?
Currently, acute stroke therapies are underutilized and access to quality stroke care varies between institutions, depending on the availability of personnel, stroke treatments and specialists. This is especially true in rural facilities, which often do not have the same resources as urban facilities. The implementation of stroke telemedicine, often called telestroke, creates an opportunity to equalize the acute management of a stroke patient, regardless of resources or geographic location.
Why REACH Call?
REACH is an easy to use, web based solution for providing both audio and video consultation for rural hospitals. With a stroke specific module embedded in the web program, the rural facility and stroke specialist have the necessary tools at their fingertips to make an accurate treatment decision.
Right now, we call the neurologist on the phone when we have a stroke patient. Isn’t that enough to provide access to the specialist?
Recent literature indicates that video consultation is more accurate than phone consultation alone. The ability for stroke specialists to visualize and evaluate the patient, using the NIHSS, has been shown to improve the accuracy of treatment decisions. (This is all from an article in the Lancet, 2008).
The neurologist usually drives in to see the patient. Isn’t that better?
Clearly, if the stroke specialist has access to evaluating the patient in the ED within minutes, this is the preferred method. However, many rural sites do not have this access. In addition, traffic, weather conditions, etc. can impair the physician’s timeliness to arriving in the ED. A major goal in acute stroke management is to reduce the amount of time from onset of symptoms to treatment decision. REACH Call provides an opportunity for the neurologist to login into any computer with internet access and provide a more accurate, timely video consultation, thus increasing the patient’s access to acute stroke therapies.
How is REACH Call different than other telestroke solutions?
The REACH advantage comes from three differentiating capabilities:
- Web-based technology for easy, efficient consults
- Insightful reports for administrative decisions
- Network building expertise for strong referral networks
REACH’s workflow was designed by neurologists for neurologists. The interface is accessible anywhere over the web from a PC with a broadband connection, and presents in one place all the necessary info/tools for completing a consult, including patient vitals and labs, images, NIHSS, physician notes, and recommendations. This helps the physician conduct the consult easily and efficiently. Furthermore, a reduced consult time can accelerate the time it takes for the patient to receive tPA. Again, time saved is brain saved.
Because it houses the user applications in a central location over the web, REACH is able to capture all the consult data for later meta-analysis and reporting. Administrators find this very useful to access customizable reports on onset to treatment times, tPA decisions, patient transfers, etc. to gain insights on how they can fine-tune the performance of their network, improve outcomes, and increase marketing.
We use clinical neuroscience nurses and experienced engineers for our implementation. These are people who have built and run successful stroke programs – they have “walked the walk” and understand how challenging it can be for a hospital to get started with order sets, protocols, financial arrangements, and licensures. Even our sales consultants and former hospital administrators have built their own networks and guide prospective customers through the considerations of developing a telestroke network.
Our interface and modules were developed and refined by clinicians over several years of experience. We have over 1,000 telestroke consults from a number of hub hospitals showing significant improvements in patients getting tPA and faster care regardless of what that care is. This is what you strive to accomplish with your stroke program.
From a patient outcome perspective, research shows that REACH consults have on average reduced stroke patient onset to treatment times with tPA by 18 minutes below the national average. In neurology, time saved is brain saved. Furthermore, the average tPA recommendation rate with REACH is 17% (and as high as 30%) versus a national average of 2-4%.
Finally, from an economic perspective, REACH Call has developed sophisticated ROI calculators to better estimate the network’s performance.
What are the other benefits of REACH Call?
With the implementation of REACH Call, the spoke hospital will begin to align their ED processes with the requirements of a certified Primary Stroke Center (PSC), such as the establishment of an acute stroke response, order sets and pathways for the emergency management of acute stroke, and basic stroke education. The Clinical Division at REACH Call can help establish these necessary protocols, in conjunction with the hub, to promote safe, effective stroke care management and continuity of care.
Can we do more than just telestroke with REACH Call?
Yes. The REACH platform is uniquely architected for rapid development of new clinical applications. The design principles of an easily-accessible, intuitive, and complete telemedicine interface can be easily translated to psychology, burn, and trauma. We can build custom applications for your specific clinical needs.
What technology is needed to perform the consult?
How much typing do I have to do during the consult?
Little typing is required to complete the consult because the physician can create consult reporting templates that pre-fill most of their standard notes. During the consult, the physician only needs to pull up the template and change a few notes and data points as appropriate.
As a spoke hospital, can we achieve Primary Stroke Center (PSC) certification utilizing the REACH Call system?
Certainly. The use of REACH Call allows for timely access to a stroke specialist, a requirement for PSC certification. In addition, the spoke hospital would have to track the necessary performance measures required for certification. However, this does not mean that a spoke hospital will have to admit all of their stroke patients. Another major advantage to utilizing REACH Call is that it promotes the transfer of appropriate patients to a higher level of care while allowing many patients to remain at the spoke facility, closer to home and their families. PSC certification requires transfer agreements with other facilities for patients requiring this advanced level of care.
What if we do not have any neurologists to take telestroke call?
REACH Call can serve as a matchmaker to connect you with a reputed firm that provides neurology call services on an outsourced basis.
How does the doctor get paid?
The stroke specialist gets paid through several means:
- Being paid by the hospital (either the hub or spoke) to take call
- Reimbursement for telemedicine consults
- If the patient is transferred, reimbursement for care of the patient at the hub
How does the hub hospital get paid?
The hub hospital’s revenue is derived from in-patient care of patients that have been transferred from the spoke to the hub. Revenues occur for:
- Facility stay
- Procedure rooms
- Medications and supplies
- ER Visits
- Downstream procedures
Does the neurologist have to be credentialed at the spoke hospitals?
Yes. REACH Call’s clinical consultants can help with the process of identifying the credentialing that needs to take place.
Who makes the decision to give tPA?
The stroke specialist makes the recommendation. The ED physician makes the decision, often consulting with the patient’s family after the stroke specialist has made a recommendation.
Who makes the decision to transfer (or not transfer) the patient?
The stroke specialist makes the recommendation. The physician attending to the patient at the spoke hospital makes the decision to transfer (or not transfer).
Can the spoke check for contraindication and warnings?
Yes. The spoke side of the application includes a panel for viewing and checking off all contraindications for tPA.