A Telemedicine Opportunity or Distraction?

This undisguised case, based on field research, describes the Partners TeleStroke service, which enables specialist doctors at Partners’ two Boston teaching hospitals (Massachusetts General Hospital and Brigham & Women’s Hospital, both members of Partners’ Health Care) to provide patient-present acute stroke consultations to generalist doctors at community hospitals. The case supports student discussion of organizational issues in the deployment of innovative networked IT applications for cross-boundary collaboration. The context of use is high urgency: doctors must determine whether to administer a drug which can both save a patient’s life and dramatically reduce post-stroke disability such as paralysis and speech loss. However, the drug, tPA, can be harmful – even deadly – to some patients. Clinical information relevant to this highly consequential decision must be gathered under time pressure, since the patient cannot receive tPA if more than 3-4 hours have passed since the time s/he was last seen well. The case describes the development and current status of TeleStroke. The executive director of this program needs to decide whether and how to respond to a request from a participating hospital. Nurses there have asked him for help in expanding the use of telemedicine applications in which doctors from a variety of clinical specialties – such as critical-care pediatrics – would provide online consultations, compensating for that hospital’s lack of such specialists.