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Aspen hospital taps stroke specialists via new telemedicine hookup

Janet Urquhart
The Aspen Times
Aspen, CO Colorado
Dr. Chris Fanale, stroke neurologist at Swedish Medical Center in Denver, can consult with physicians at Aspen Valley Hospital, and assess a patient’s condition, via the hospital’s new Colorado Digital Online Consultant technology.
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ASPEN – It’s about 160 miles from Denver to Aspen, but now a Denver neurologist can examine a possible stroke victim at Aspen Valley Hospital in the time it takes to boot up a laptop computer.

Call it telemedicine.

The Aspen hospital’s latest piece of diagnostic equipment isn’t so much about high-tech gadgetry as it is people. The Colorado Digital Online Consultant – CO-DOC, for short – is making its debut in the Aspen emergency department, bringing Denver specialists into the examining room via tiny, computer-mounted cameras.

The system brings the stroke expertise of Swedish Medical Center to rural hospitals. Aspen is the 12th facility to hook up.

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“We live in a rural area. We don’t have a neurologist who can run to the E.R. to help us,” said Dr. Catherine Bernard, emergency room physician at AVH and chairwoman of the emergency department. “It’s key to us to have this.”

It used to be that little could be done for a stroke victim, according to Bernard, but now, a drug treatment that is both effective but also potentially dangerous can dissolve the blood clot causing the stroke and prevent permanent damage, or even death, that could otherwise result.

The drug, however, must be administered in a narrow window of time and only when a host of factors make the treatment appropriate for the patient. It might be administered on a handful of occasions over the course of a year in Aspen, according to Bernard.

“The beauty of having the experts in Denver is this is a decision they make all the time,” said Amy Covington, emergency department director at AVH.

A specialist in Denver is available 24 hours a day through the system; on-call doctors at Swedish can connect with AVH via a laptop from any location where Internet service is available.

The system allows real-time interaction between the specialist in Denver and the patient, the patient’s family and the physician in Aspen. While the remote doctor appears on a bedside screen that projects the typical webcam-quality image, the camera pointed at the patient gives the specialist a high-resolution image, detailed enough to examine the patient’s pupils, for example.

“They can do everything but touch and smell the patient,” Covington said.

Talking to and observing a patient’s movements are valuable diagnostic tools, and the eye-to-eye contact helps establish a doctor-patient relationship that a telephone call can’t create, according to Dr. Chris Fanale, stroke neurologist at Swedish.

If the patient is treated with the drug, called tissue Plasminogen Activase (tPA for short), he or she will typically be transported to Swedish for follow-up care.

“They always say that I look much better over the camera,” Fanale quipped.

Strokes are the main cause of disability in the United States and Europe, according to Bernard, and despite medical advances, the key remains early detection and treatment.

For most patients, tPA must be administered within three hours of the first signs of a stroke, she said. People shouldn’t hesitate to call 911 or get quickly to a hospital if they suffer symptoms, which can include a facial droop or uneven smile, arm numbness or weakness, or slurred speech or difficulty speaking or understanding.

Someone who suffers such symptoms temporarily should also seek medical help, as they can be signs of a coming stroke, Bernard said. In the moment, a person can’t know if they are suffering a pre-stroke symptom or the real thing, she added.

The hospital’s CO-DOC equipment was a $20,000 investment. In addition, the hospital contracts with Swedish Medical Center for its services.

“If we prevent one person from suffering a disability from a stroke, the $20,000 is worth it,” Covington said.

janet@aspentimes.com


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