NAME OF NETWORK     
Virginia Acute Stroke Telehealth Network (VAST)

Name of Grantee                 
Virginia Department of Health, Office of Minority Health and Public Health Policy              
Principal Investigator/Project Manager
Cynthia Barrigan, Executive Director, Virginia Telehealth Network
Address  PO Box 2356 Centreville, Virginia 20122
Phone 703-802-4878
Fax   1-888-205-0114            
Organizational Website www.ehealthvirginia.org         
E-mail cbarrigan@ehealthvirginia.org

Project Purpose

Virginia’s incidence and mortality rates for stroke are among the highest in the nation – a vexing problem for the State’s health care providers. The Institute of Medicine of the National Academy of Science and the American Stroke Association has concluded that the fragmentation of stroke systems of care contributes to the magnitude of this health problem—especially in rural and underserved communities.

The American Stroke Association, a division of the American Heart Association, says that a community’s stroke system of care must include certain fundamental components ((Stroke. 2005; 36:690.) http://stroke.ahajournals.org/cgi/content/full/36/3/690):

• Primary prevention
• Community education
• Notification and response of emergency medical services
• Acute stroke treatment
• Subacute stroke treatment and secondary prevention
• Rehabilitation
• Continuous Quality Improvement Initiatives

The lack of focused health information technologies (HIT) that enable health information exchange (HIE) and the delivery of remote telehealth/telemedicine services (TH/TM) are partially responsible for serious disruptions in continuity of care as stroke patients move from one level of care and care provider to another throughout Virginia’s health care system. Further, the lack of integrated HIT capabilities that enable the rapid and efficient transfer of patient data and digital images impedes the timely diagnosis and treatment of stroke victims.

The purpose of the Virginia Acute Stroke Telehealth Network (VAST) is to design, development, test and evaluate a model stroke network across the Central Shenandoah Region. HIT will be implemented at Bath Community Hospital—a critical access hospital-- and its supporting hospitals as part of a regional stroke quality improvement initiative. The intent of this project is to examine the first four components of the stroke continuum of care—Prevention, Community Education, EMS Notification and Acute Treatment—and introduce HIT solutions--along with other interventions-- to strengthen , improve and more tightly integrate these components of the stroke systems of care. It is envisioned that this model would be considered for state-wide adoption.
Primary Objectives

• Increase awareness of stroke signs and symptoms and best practices in stroke care.

• Improve the stroke EMS response.

• Accelerate time to diagnosis and treatment of acute stroke

Outcome Measures/Expectations

Prevention/Community Education

• Develop and implement a centralized stroke website for Virginia (virginiastrokenetwork.org) that patient/providers can use to access information on national and state-level stroke initiatives, stroke policy, best practices, VAST, and receive on-line stroke education and training.

EMS Notification and Response

• Develop a Stroke EMS Plan for the Region
• Develop electronic stroke training materials and standardized protocols.
• Implement a web-based learning management system.
• Deliver on-line stroke training to EMS providers.

Acute Treatment

• Deploy critical tele-stroke infrastructure which includes: the RP-7 Remote Presence System to facilitate remote neurology stroke consults; the implementation of PACS and integrated tele-radiology solutions to enable the digital capture, transfer, archiving and on-going sharing of CT scans for rapid interpretation across the network; and improvements to the existing CPSI electronic medical record system for enhanced medical documentation of stroke in the Emergency Department.

Service Area

The service area for the project spans the entire Central Shenandoah Valley---- with a special emphasis on Bath County which is a designated Medically Underserved Area (MUA).   The Central Shenandoah Valley Region is located in the middle of the historic and scenic Shenandoah Valley in west-central Virginia. It has a land area of 3,439 square miles; the Region is home to some 246,400 persons. Geographically, the Region is the largest health planning district in the state.

The Region is comprised of five counties (Augusta, Bath, Highland, Rockbridge and Rockingham); five independent cities (Buena Vista, Harrisonburg, Lexington, Staunton, and Waynesboro); and eleven towns (Bridgewater, Broadway, Craigsville, Dayton, Elkton, Glasgow, Goshen, Grottoes, Monterey, Mt. Crawford and Timberville).  

According to the U.S. Census, Bath County’s population is approximately 4,814.   Persons over age 65 make up 19.4% of the county as compared to 11.4% of the State’s population.  The median household income in Bath County (2000) was $38,145 as compared to the State median of $51,103. 

Network Members

Equipment/Vendors or Collaborative Partners

Vendors 

• InTouch Health: RP-7 Remote Presence System: Uses a mobile robot with live untethered video-teleconferencing capability and allows a stroke neurologist to immediately initiate an assessment from any location using a remote control joystick to pilot the robot in the remote environment without assistance from the remote community ED.

• Computer Programs and Systems, Inc (CPSI):  Electronic Forms Module:  Replaces paper-based patient data and care forms with user-defined electronic ones. Displayed and completed on-line using Microsoft's Internet Explorer, the module's forms are easy to use and can be customized to meet such needs as ED triage, trauma, assessments, modality worksheets, consent for treatment, information release requests, transfers, etc. 

• PACS Vendors being evaluated include DR Systems, CPSI and Carestream.

Collaborative Partners

• American Heart Association (Mid-Atlantic Affiliate)
• Edward Via Virginia College of Osteopathic Medicine (VCOM)
• Virginia Department of Health - Division of Chronic Disease & Control
• Virginia Department of Health – Office of Minority Health and Public Health Policy
• Virginia Health Quality Center
• Virginia Stroke Systems of Care Collaborative
• Virginia Telehealth Network
• Winchester Medical Center - Valley Health

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