title: Feasibility and utility of an integrated medical imaging and informatics smartphone system for management of acute stroke.
abstract: Background Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members are essential for optimal acute stroke care. Aim To characterize the feasibility and utility of the Synapse Emergency Room mobile (Synapse ERm) informatics system. Methods We implemented the Synapse ERm system for integration of clinical data, computerized tomography, magnetic resonance, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results From May 2014 to October 2014, the Synapse ERm application was used by 33 stroke team members in 84 Code Stroke alerts. Patient age was 69.6 (±17.1), with 41.5% female. Final diagnosis was: ischemic stroke 64.6%, transient ischemic attack 7.3%, intracerebral hemorrhage 6.1%, and cerebrovascular-mimic 22.0%. Each patient Synapse ERm record was viewed by a median of 10 (interquartile range 6-18) times by a median of 3 (interquartile range 2-4) team members. The most used feature was computerized tomography, magnetic resonance, and catheter angiography image display. In-app tweet team, communications were sent by median 1 (interquartile range 0-1, range 0-13) users per case and viewed by median 1 (interquartile range 0-3, range 0-44) team members. Use of the system was associated with rapid treatment times, faster than national guidelines, including median door-to-needle 51.0 min (interquartile range 40.5-69.5) and median door-to-groin 94.5 min (interquartile range 85.5-121.3). In user surveys, the mobile information platform was judged easy to employ in 91% (95% confidence interval 65%-99%) of uses and of added help in stroke management in 50% (95% confidence interval 22%-78%). Conclusion The Synapse ERm mobile platform for stroke team distribution and integration of clinical and imaging data was feasible to implement, showed high ease of use, and moderate perceived added utility in therapeutic management.
authors.affiliation: 1 Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Shkirkova
authors.affiliation: 2 Vanderbilt School of Medicine, Nashville, TN, USA.
authors.forename: Eftitan Y
authors.initials: EY
authors.lastname: Akam
authors.affiliation: 1 Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Josephine
authors.initials: J
authors.lastname: Huang
authors.affiliation: 3 Department of Neurology and Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Sunil A
authors.initials: SA
authors.lastname: Sheth
authors.affiliation: 3 Department of Neurology and Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: May
authors.initials: M
authors.lastname: Nour
authors.affiliation: 3 Department of Neurology and Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Conrad W
authors.initials: CW
authors.lastname: Liang
authors.affiliation: 1 Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: McManus
authors.affiliation: 4 Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Van
authors.initials: V
authors.lastname: Trinh
authors.affiliation: 4 Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Duckwiler
authors.affiliation: 1 Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Tarpley
authors.affiliation: 4 Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vinuela
authors.affiliation: 1 Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000208:Acute Disease; D000368:Aged; D000792:Angiography; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D003142:Communication; D019468:Disease Management; D004632:Emergency Medical Services / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008490:Medical Informatics / Q000379:methods*; D063731:Mobile Applications; D010348:Patient Care Team; D000068997:Smartphone; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D017216:Telemedicine; D014057:Tomography, X-Ray Computed
keywords: Acute stroke; mobile information system; stroke care; stroke management; stroke team; telemedicine