SACRAMENTO — There are days when Medical Director of Neurology at Mercy Health Alan Shatzel needs only his laptop and his expertise to diagnose stroke patients. The robot does the rest. 

With access to the Mercy Telehealth Network, Shatzel can diagnose in real time stroke patients in emergency departments in the Central Valley and Northern California from Bakersfield to Redding. By connecting electronically with a robot in the ED, he can zoom in next to the patient, listen, ask questions and perform a sort of virtual examination. His face appears on the robot’s computer screen.  

“That’s the beauty of telemedicine,” Shatzel said. “It breaks down those barriers and allows specialists clustered in metropolitan areas to reach needs in rural areas.” 

And that means saving lives.

The Mercy Neurological Institute has operated its telehealth program for stroke patients since 2008 and just recently expanded the network to its 11th partner — Mark Twain St. Joseph’s Hospital in San Andreas.

Robots Put Neurologists With Patients in Real-Time

A robot called RP-lite — the most often used in the network — has a high-definition computer monitor with optics that allow the doctor to zoom in on the patient. The doctor uses a mouse, a touch screen or a joystick to move the robot around and turn the head.

“There’s a lot of functionality to them, which allows us to actively participate in bedside care,” Shatzel said. “When you first start doing these evaluations, it feels strange, but when you’re in the heat of the moment, all that falls away.”

Doctors can control robots not only from their desktop computer or laptop but also, beginning in January 2013, through an iPad application. Doctors also can call up images on their computers of a patient’s CT scan. “They can do a very thorough diagnosis of the patient,” Jim Roxburgh, director of the Mercy Telehealth Network, said.

Shatzel said that when he first logs onto the robot, he introduces himself and then starts the evaluation.

“You could never do this over the phone. Through the robot, I’m inside the room, and I’m using my vision and my hearing,” said Shatzel.

Doctors can’t touch the patient using the robot, but for other telemedicine services such as pulmonary critical care, the device can be connected to a stethoscope or an ultrasound probe so the doctor can hear or see what’s going on inside the body. 

Network Allows Hospitals To Become Primary Stroke Centers

The network started after the Elliot Family Foundation, a philanthropic arm of builder and developer Elliott Homes, gave Mercy Telehealth Network a grant to improve stroke care at Mercy Hospital in Folsom. Since then, all 11 partner sites have become primary stroke centers for their regions.

The hospitals can earn certification as primary stroke centers because of the network’s ability to have neurologists available 24 hours a day, seven days a week. The network never shuts down, and when a neurologist is on duty for the network, that’s all he or she does, unencumbered by other work.

“We go into a hospital and help build the program and make sure they get to patients in a timely manner,” said Shatzel.

Bakersfield Memorial has been part of the network for two years. “There’s no question that the [telemedicine] group is phenomenal,” said Les Burson, the ED medical director at Bakersfield Memorial.

“There was a lot of trepidation at first. What would families think of a robot coming into the room, one that turns its head and examines the patient?” he said of the program.

But that fear didn’t last long, he added. “You’ve got a board certified neuro-radiologist looking at the patient in real time, talking to the patient and the family.” 

Telehealth Facilitates Use of Clot-Busting Medication

The telehealth network benefits patients who have had ischemic strokes and are potentially eligible for the FDA-approved clot-busting medication called tPA. The medication must be administered within about a three-hour window after a stroke — one reason why it’s so vital that EDs have immediate access to neurologists, supporters said.

If tPA is given in time, the drug can significantly reduce the effects of stroke and reduce permanent disability.

“Making these decisions requires some specialty knowledge and experience and unfortunately, a lot of ERs don’t have access to that specialty knowledge,” Shatzel said, adding, “The [telemedicine] link allows us to have this core group of stroke neurologists at the bedside of patients in minutes.”

Typically, only 3% to 4% of those going to a hospital ED for stroke receive tPA. Not everyone with an ischemic stroke qualifies for tPA, but in hospitals that have received a stroke certification, the percentage of patients receiving it is around 20%, which is about the number who should receive tPA, neurologists said. “That’s a big gap,” Roxburgh said.

Since the network started four years ago, Mercy Telehealth has done about 650 telehealth consultations, with the numbers increasing each year. About 23% of telehealth stroke patients received tPA.

“That’s important if you look at a rural hospital without ready access to its own neurologist, they’re treating the patient optimally,” Roxburgh said.

The network, continually working on improving its response time, has whittled it down to a time shorter than it takes to page most doctors, officials said. “Within an average of five minutes, our doctors have beamed into our partner sites,” said Roxburgh. “That’s where this really hits home.” 

Roxburgh says these types of networks are slowly becoming the standard of care for rural hospitals and will increase over the next few years, especially with the shortage of specialists.

About 70% of patients who receive tPA from a hospital in the network don’t need to be transferred to a specialty hospital. “The goal is to keep patients in their own communities, but sometimes they need to be transferred for a higher level of care,” said Roxburgh.

Stroke is the No. 1 cause of disability and the No. 4 cause of death in the United States. Neurologists and telehealth supporters say widespread use of new technology in systems like the Mercy Telehealth Network will mean more patients benefit from the highest levels of care.

“The one thing that best defines this is access to care,” Shatzel said.

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