Time is Brain: How Image-Enabled HIEs Can Deliver Better Care for Stroke

eHealth Technologies Blog: Gary Larson, Executive Vice President, General Manager, HIE Solutions at eHealth Technologies

Before you finish reading this blog post and move on to other aspects of your busy life, at least one person in the US will suffer from a stroke, probably more. According to the National Stroke Association, every 40 seconds, the clock starts ticking for another American as their brain begins to be deprived of oxygen. Whether they fully recover, die, or suffer through serious long-term disabilities will depend on the quality and speed of the care that they receive.

After nearly a decade enabling Health Information Exchanges (HIEs) with the ability to ubiquitously share medical images, eHealth Technologies is in a unique position to dramatically improve the treatment and outcomes for one of the most devastating diseases in healthcare. The National Stroke Association reports that stroke is the #5 cause of death in the US, and the #1 cause of long-term disability. Every 4 minutes someone dies of stroke.

Allow me to demonstrate the important role medical imaging, and access to and sharing of images impacts stroke diagnosis and treatment:

When a patient presents at a local emergency department suffering with stroke symptoms, the first order of business will be to perform a brain imaging study – frequently a CT Angiography study – and have it interpreted by a neurologist or neuro-radiologist. Imaging is the only way to determine whether the patient is suffering from an ischemic stroke (a clot that impedes blood flow) or hemorrhagic stroke (bleeding around brain tissue). Each requires an entirely different treatment protocol; and for each the key to a successful outcome is diagnosing and beginning treatment as quickly as possible.

 Time is Brain.  Some ischemic strokes, which make up 85% of the total strokes in the US, require an endovascular clot retrieval procedure that is generally only performed in a JCAHO certified Comprehensive Stroke Center. Other ischemic strokes are best treated by retaining the patient at the local facility and administering clot-busting drugs such as a Tissue Plasminogen Activator (tPA).

Time is brain is a drumbeat frequently heard in stroke treatment circles but is much easier said than done. Critical decisions must be made quickly and accurately –-such as whether to treat or transfer a patient and what course of treatment will be effective – and are dependent on medical images being readily available to neurologists in full diagnostic quality. This is complicated by the fact that there may be only one or two such highly-qualified specialists available in a region or state at any given time. These critical images could reside on a multitude of isolated hospital networks and stored on a wide array of PACS technologies. Patients may be unconscious and known only as “John or Jane Doe.” Care providers across the community might be required to log into one of numerous systems to access these records or may resort to driving many miles to the hospital just to view these critical images. Ancillary data, such as prior history and whether the patient is taking blood thinner medications, can be difficult to access, yet critical to decision making. These and many other factors present a unique set of challenges that make it extremely difficult to expedite decision making for stroke care without an image-enabled Health Information Exchange.

Time is brain is one of the key reasons why Emergent Imaging Workflow is included in our eHealth Connect® Image Exchange for HIEs solution. With Emergent Imaging Workflow enabled, a neurologist can log into an HIE portal and view imaging studies for every current stroke patient at all connected facilities across the community served by the HIE in one place. Regardless of the time of day or night, whether these highly-trained specialists are at home, in their home hospital, or travelling overseas, they can view any stroke imaging study in full diagnostic quality with a single click, minutes after it was acquired. This assures that most critical care decisions in stroke diagnosis and treatment are made as quickly and accurately as possible.

With Emergent Imaging Workflow, up to an hour can be shaved off of the time between a patient first presenting with stroke symptoms and the best course of treatment being administered. An hour can mean the difference between living a life with permanent brain damage, paralysis, or even death, and a full life unimpaired by the ravages of stroke.

Because, after all, time is brain.