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MUSC to be named telemedicine hub

by Dawn Brazell
Public Relations
Most people just see a cart with a computer and camera. But Robert Adams, M.D., pioneer of telemedicine at MUSC, sees much more. He sees the mobile cart as a portal for forming medical partnerships and saving lives.
“It’s a human touch that is very much appreciated at a very difficult time,” said Adams, a neurologist and the director of the Stroke Center of Economic Excellence supported by Health Sciences South Carolina. The video link-up is two-way, so specialized doctors can make face-to-face contact with the staff, families and patients in partner hospitals that don’t have 24/7 stroke experts.
 This consult is critical to help assess the safe use of tPA, a “clot-busting” drug. Even though the drug is FDA-approved, it is a little-used treatment for ischemic stroke because of potential side effects.
“We’re able to say, ‘Yes, your loved one has had a stroke, but we’re going to take care of them, and we do this every day.’ When you look at the tPA experience of all the eight consultants, it’s really extensive. Our willingness to make a decision quickly is enhanced by our experience.”
Time is brain, said Adams, whose mission in life is to improve the quality of stroke care throughout South Carolina. It means that he and his team take calls in shifts in addition to their normal duties, but Adams said the juggling is well worth the time.

It’s one reason he’s the recent recipient of the Lewis Blackman Patient Safety Champion Award. The awards are named in honor of Lewis Blackman, a 15-year-old who died in 2000 after an elective surgical procedure due to potentially preventable medical complications. Adams, who came to MUSC in 2007 as a neurologist and professor in the Department of Neurosciences, led efforts to implement the REACH (remote evaluation of acute ischemic stroke) Network in 2008. The network aims to make acute stroke care available to other hospitals throughout the state via telemedicine using an Internet link/Web site.
“I personally, did not merit this award. I think the whole REACH program was given the award and that’s how I would like it to be seen,” said Adams.
In just 18 months, Adams and his team recruited nine hospitals to the REACH Network: Coastal Carolina Medical Center, Georgetown Memorial Hospital, Grand Strand Regional Medical Center, Marion County Medical Center, McLeod Health, Piedmont Medical Center, Self Regional Healthcare, Waccamaw Community Hospital, and Williamsburg Hospital.
The hospitals have 24/7 access to MUSC stroke experts who assist local emergency-room physicians on the diagnosis and treatment of stroke patients. Adams said team members have done more than 450 stroke consults since May 2008. The use of tPA to treat ischemic strokes has increased dramatically at REACH Network sites.
College of Medicine Dean Jerry Reves, M.D., said prior to Adams’ implementation of the REACH Network, tPA was used in less than 1.5 percent of stroke cases, leaving patients in rural South Carolina with little or no access to a neurologist creating a high probability of permanent disability or death. Nearly one-third of the patients evaluated by a REACH expert was diagnosed as having an ischemic stroke and given tPA.
“The increased use of tPA makes the potential for saving lives and returning patients to pre-stroke health and reversing the devastating effects of stroke in South Carolina very real, “ said Reves.
Nationally, there are 750,000 strokes a year, but only 700 vascular neurologists who are specialists in stroke treatment. Adams, who helped develop a stroke certification process for hospitals through the American Stroke Association (ASA), said there are about 750 certified centers around the country, which is about 15 percent of hospitals.
MUSC became certified as a primary stroke center in July 2007 and is to receive an award from ASA for being the first stroke telemedicine “hub” in the state. Adams said the six original “spoke sites” also will be receiving ‘Stroke Pioneer’ citations for being the first spokes.
“It’s a terrible brain injury going on in a stroke, and you don’t want to go just anywhere to be treated. You can’t always plan your stroke to be near a hospital that has that certification. It will take too long, even with helicopters, to get the care they need. We have to Web-enable sites so patients won’t lose time that’s so critical.”
 Telemedicine makes sense given the maldistribution of experts, the scarcity of stroke centers and the increased awareness of stroke symptoms and availability of treatment, he said. In addition to acute assessment of patients, the network also allows stroke experts to make recommendations for advanced follow-up treatment.
Adams and several MUSC faculty members serve on an 18-member legislative study committee under the Department of Health and Environmental Control that is charged with developing a statewide system of stroke care. He is thrilled to see how telemedicine has taken off more rapidly than he thought it might. Adams sees telemedicine continuing to grow geographically, but also expanding into other platforms, such as sepsis, trauma and ICU care, he said.
 “It has been extremely rewarding. Our team that handles this is really terrific. The hospitals we work with and the nurses and the physicians are really dedicated. REACH is not just a cart with a computer and a camera on it; it’s a partnership. That partnership is about improving stroke care.”


Friday, April 30, 2010

The Catalyst Online is published weekly by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. The Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, Editorial copy can be submitted to The Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.