title: A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue.
abstract: BACKGROUND
  To assist small hospitals in providing advanced stroke treatment, the Norwegian Directorate of Health has recommended telemedicine services. Telestroke enables specialists to examine patients via videoconferencing supplemented by teleradiology and to provide decision support to local health care personnel. There is evidence that telestroke increases thrombolysis rates. In Norway, telemedicine has mainly been used in non-critical situations. The first telestroke trials took place in 2008. The aim of this paper is to present an overview of telestroke trials and today's status with telestroke in Norway. Based on the divergent experience from two health regions in Norway, the paper discusses crucial factors for the integration of telestroke in clinical practice.
  
  
  METHODS
  This is a descriptive study based on multiple methods to obtain an overview of the practice and experience with telestroke in Norway. A Web and literature search for 'telestroke in Norway' was performed and compared with a survey of telemedicine services at the country's largest hospitals. These findings were supplemented by interviews with key personnel involved in telestroke in two of four health regions, as well as hospital field observations and log data of telestroke transmissions from five of the hospitals involved.
  
  
  RESULTS
  In Norway, experience in telemedicine for acute stroke care is limited. At the beginning of 2014, three of four regional health authorities were working with telestroke projects and services. Integration of the service in practice is challenging, with varying experience. The problems are not attributed to the technology in itself, but to organization (availability of staff on duty 24/7 and surveillance of the systems), motivation of staff, logistics (patient delay), and characteristics of the buildings (lack of space).
  
  
  CONCLUSIONS
  Prerequisites for successful integration of telestroke in clinical practice include realization of the collaboration potential in the technology with consistent procedures for training and triage, availability of the equipment, and providing advice beyond questions concerning thrombolysis.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, PO Box 35, NO-9038, Tromsø, Norway. tove.sorensen@telemed.no.
authors.forename: Tove
authors.initials: T
authors.lastname: Sørensen
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, PO Box 35, NO-9038, Tromsø, Norway. kari.dyb@telemed.no.
authors.forename: Kari
authors.initials: K
authors.lastname: Dyb
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, Kirkeveien 9, NO-4816, Kolbjørnsvik, Norway. ellen.rygh@telemed.no.
authors.forename: Ellen
authors.initials: E
authors.lastname: Rygh
authors.affiliation: Nordland Hospital, NO-8092, Bodø, Norway. rolf.salvesen@nlsh.no.|University of Tromsø, 9038, Tromsø, Norway. rolf.salvesen@nlsh.no.
authors.forename: Rolf
authors.initials: R
authors.lastname: Salvesen
authors.affiliation: Haukeland University Hospital, NO-5021, Bergen, Norway. lars.thomassen@helse-bergen.no.
authors.forename: Lars
authors.initials: L
authors.lastname: Thomassen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003199:Computer Systems; D003422:Critical Care; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009664:Norway; D036301:Qualitative Research; D020521:Stroke; D017216:Telemedicine / Q000379:methods*; D019112:Teleradiology; D049269:Videoconferencing; D055815:Young Adult