Telestroke 10 years later--'telestroke 2.0'.
BACKGROUND
The lack of physicians with specialty stroke training represents a significant challenge to the future of stroke. This deficit limits both quality stroke care and clinical research initiatives.


METHODS
The use of telemedicine for stroke ('telestroke') has been an attempt to overcome this shortage and extend stroke expertise to locations which lack coverage. However, the initial telestroke systems required a point-to-point connection for transmission and only provided videoconferencing which limited their generalizability and usefulness. 'Telestroke 2.0' is the authors' vision of an integrative web-based telestroke system combining high-quality audiovideo transmission, the ability of consults and teleradiology to be carried out from any desktop or laptop computer with web-access, decision and technical support, creation of billable physician documentation and electronic medical record connectivity.


RESULTS
These features will facilitate the development of statewide and regional telestroke call networks with an opportunity for physician supply companies to fill in coverage gaps. In addition, telestroke 2.0 may improve acute stroke research by increasing trial efficiency via the addition of non-academic recruitment sites, enhancing trial validity by centralizing neurologic examinations via recorded encounters, and generalizing clinical trial results to community hospital settings.


CONCLUSIONS
Greater diffusion and long-term sustainability of telestroke systems will be dependent upon improvements in patient and hospital reimbursement for acute stroke and telestroke care.
Switzer
Jeffrey A
JA
Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA. jswitzer@mcg.edu
Levine
Steven R
SR
Hess
David C
DC
D000067:Accounts Payable and Receivable; D035843:Biomedical Research; D002986:Clinical Trials as Topic; D020000:Decision Support Systems, Clinical; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007349:Insurance, Health, Reimbursement; D020407:Internet; D016347:Medical Records Systems, Computerized / Q000191:economics / Q000458:organization & administration; D009462:Neurology / Q000191:economics / Q000458:organization & administration; D009937:Organizational Objectives; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration; D019114:Remote Consultation; D012107:Research Design; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration; D019112:Teleradiology; D013997:Time Factors; D049269:Videoconferencing / Q000191:economics / Q000458:organization & administration; D000078329:Workforce