March 16, 2012

Heather M. Linn, MDBoard Certified NeurologistUniversity of Texas Medical BranchClinical Neurophysiology Fellow, Baylor College of Medicine

Currently a full time Teleneurologist for Specialists On Call

• Provide 24/7 neurology on-call, now psychiatry on-demand to more than 180 hospitals in 21 states

• Support emergency departments, hospitalists, ICU’s

• Heavy emphasis on quality:

– Doctors - over 55 neurologists

– Practices, processes & protocols – 15 minute guaranteed response

– Technology – FDA approved, encrypted and HIPAA Compliant

– Joint Commission Accredited - since May 2006

• Unique business offering and pricing model for hospital clients

• 3 of the top ten university neurology departments in U.S. collaborate with & take call for SOC

• More emergency neurology consultations than any traditional provider, >40K

• More acute stroke consultations than any tertiary institution

• More tPA administered than any institution worldwide (2X)

•

Cost, quality, patient satisfaction all suffer in the absence of effective on-call coverage

Call coverage is increasingly punitive & undesirableCall coverage is increasingly punitive & undesirable

Specialty physician shortage is increasingSpecialty physician shortage is increasing

Underserved no longer means just ‘rural’Underserved no longer means just ‘rural’

Demand for specialty consults is increasingDemand for specialty consults is increasing

Stipends are growing as a burden to systemsStipends are growing as a burden to systems

Teleneurology is the delivery of remote consultative servicesfor any neurologic emergency via a telemedicine platform thatincludes the following:

• 100% Secure Network with Dual Redundancy• High Definition Video End Points with Stereo Audio• PACS• EMR• 24/7/365 Live Technical Support• Operational Support (scheduling, licensing & credentialing)• Strict Clinical Protocols• Dedicated Team of Neurologists• Attractive Physician Compensation

Teleneurology is clinically effective and viable as a servicebecause it’s comprehensive.

Telestroke is an empty proposition due to its limitations.

• It doesn’t answer the question “Is this a stroke?” and telestroke protocols are typically for established stroke patients.

• It fails to relieve the need for local neurology on-call coverage.

• It’s employed primarily as a referral-grabbing tool.

32%

59%

6% 3%

Annual Clinical Recommendation Profile Non Stroke Neurologic Non-tPA Stroke or TIAtPA Recommendation ICH Recommendation

• Anoxic Brain Injury• Bell Palsy• Demylenating Disease• Encephalopathy • Hypertensive Encephalopathy• Migraine/Headache• Other• Psychogenic

• SAH• Seizure• Syncope• Transient Global Amnesia• Trauma/TBI• Tumor• Vestibulopathy

• Allows hospitals to treat stroke patients with confidence & clinical consistency

• Eliminates EMS diversions• Reduces unnecessary patient transfers• Satisfies staffing requirement for Primary Stroke Center

certification• Supports ER staff & improves department efficiency• Provides a competitive advantage in local marketplace• Relieves the burden of on-call coverage for local neurologists• Serves as a recruiting advantage for physicians

Why Georgia remains a member of the “Stroke Belt”

• 9,829,000 total state population• 21% of state population is over 55 years old• 29% of state population have known stroke risk factors• 53% stroke mortality rate• 22 Primary Stroke Centers • 343 neurologists in state• 28,656 to 1 ratio of patients to neurologists

* Figures provided by US Census Bureau, Robert Wood Johnson Foundation Obesity Report, American

Stroke Association, SK&A Specialty report

How to implement a successful Teleneurology program:

• Don’t get caught up in the technology – the equipment is secondary to the clinical care being imported

• It’s not a “Do It Yourself” project – a successful teleneurology program takes resources, infrastructure and dedicated physicians

• Establish your goals & communicate them to all stakeholders

• Make sure local neurologists are on board with the program

• Market your new teleneurology capabilities in your community

• Opportunity to treat the patients who need help the most• Part of an innovative company that’s expanding medicine’s

overall reach & effectiveness• Member of an exceptional physician team that is defining

the very highest clinical standards possible for teleneurology

• Enjoy work/home balance