First-of-its-kind mobile phone-based software technology may allow physicians to manage and consult on stroke cases in real time from anywhere in the world, a study presented at the Society of NeuroInterventional Surgery (SNIS) 9th Annual Meeting in San Diego, USA, showed.
The telediagnostic imaging support system known as the i-Stroke System (FujiFilm), which facilitates the transfer of information and diagnostic imaging to physicians in any remote location and allows them to consult on diagnosis and treatment via a Twitter direct messaging system, is showing success in Japan and may be poised to make its entry into the US market.
As a stroke patient’s outcome is completely dependent on providing the right care within a small window of time in order to restore blood flow and preserve brain function, Yuichi Murayama, director for the Center of Endovascular Surgery at Jikei University School of Medicine (JUSC) in Tokyo, Japan, and co-inventor of i-Stroke, says this new technology can help overcome situational obstacles that can add time to the clock and delay diagnosis and treatment.
“As every minute is crucial when dealing with stroke, it is my belief that for those patients eligible for treatment, especially endovascular therapy which requires surgical preparation, this technology can significantly improve on the patient’s ‘door to treatment’ time which, in turn, has significant implications for the patient’s prognosis.”
In reporting on the use of i-Stroke to date at the SNIS meeting, Murayama says the system, implemented in his hospital in a pilot programme in 2010, has been used in approximately 160 stroke cases. Equipped to facilitate the exchange of anonymous biographical information as well as clinical data and imaging via any smart phone, i-Stroke has “shown adequate performance and facilitated accurate and thorough information transfer, resulting in proper diagnosis and management of all 160 stroke patients.”
The system is now in place in approximately six hospitals in Japan. Murayama, along with co-inventor Hiroyuki Takao, instructor at JUSC, both of whom have joint appointments with the University of California, Los Angeles (UCLA), are now looking forward to a near-term trial in the United States to evaluate the technology’s impact on time to treatment and pave the way for a possible FDA approval.
Telemedicine has been a developing trend in recent years made possible by significant technological advancements and in response to multiple factors including patient or physician geography. To date, however, the exchange of complex information and imaging with physicians in any remote location has been limited. Now, says Murayama, the i-Stroke System allows high-quality transfer of information to a mobile phone which means that physicians can work from any place where they have a cell phone signal.
The idea was conceived in 2008, continues Murayama, when he was navigating a practice schedule that required him to be in Tokyo for three weeks out of the month and Los Angeles for one week. A neurointerventional practitioner who specialises in endovascular therapy (EVT), Murayama is dependent on multiple pieces of information in order to both diagnose stroke and make a determination about the patient’s candidacy for EVT. Realising that a system that would allow him to visualise all the various pieces of a stroke patient’s work-up from an airport or across the world in order to provide consultation and expert opinion to physicians on the ground who are managing the stroke case, Murayama began working with Takao, who he credits as the technological genius behind the invention, to bring the concept to fruition.
The result is the first-ever mobile-optimised technology that transfers clinical and imaging information necessary to diagnose stroke, such as as computed tomography (CT) scans, magnetic resonance imaging (MRI), and CT angiograms, plotted on a three-hour timeline to help the remote physician visualise the patient’s stroke progression against the clock. In addition to this information, which is downloaded onto a “stroke server” installed in the hospital, the technology includes tools to help manage the diagnostic information, such as the patient’s NIH Stroke Scale score, vital to the diagnostic process. If the patient goes to treatment, the technology facilitates continuous care by providing the physician with opportunities to visualise the procedure as it unfolds, with complete access to intra-operative images that allow for ongoing feedback and input to physicians in the operating room.
When considering how the technology could be applied in various hospitals around the world to expedite time to treatment, Murayama says the possibilities are endless. “There are multiple factors that play into the time equation where it concerns stroke diagnosis and treatment,” said Murayama, “including whether the patient presents at a hospital equipped to treat stroke, a physician’s whereabouts at the time the patient arrives at the ER, or just the in-hospital process often associated with alerting all the specialists involved in stroke care and initiating the multi-step process required to obtain the information to make the correct decisions about treatment. This technology can help eliminate wasted time in any one of these situations for the complete benefit of the patient.”
One of the main models for which the i-Stroke was designed is the hospital “hub-spoke” structure, whereby the hub has the necessary specialists and resources to treat stroke, yet the patient may present at a “spoke” hospital. In these cases, Murayama says, physicians at the spoke hospital who may suspect a stroke can initiate imaging and share those scans with the hub hospital as well as specialists who many not even be in town while transferring the patient. “This step alone can save invaluable time as the hub physicians have all the information at its fingertips to understand the patient’s status and make decisions about next steps before the patient even arrives.”
In the United States alone, where there are only about 200 stroke centres, Murayama believes the technology would find a receptive audience. “As physicians, our goal is to continually advance the science and technology that make better patient care possible. That is what i-Stroke is all about.”