|MUSC to be named telemedicine hub
by Dawn Brazell
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
“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
“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
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,”
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