| Telestroke, a sub-category of teleneurology, is a web-based approach to treating stroke victims who have not been admitted to a hospital. Strokes, which are caused by the sudden death of brain cells due to a lack of oxygen, are the third leading cause of death in the United States. Time is very important when treating a stroke; patients who are treated within 90 minutes of a stroke have a significantly lower risk of permanent brain damage or death. For this reason, telestroke services are especially useful to patients in rural areas, where acute-care hospital services are often hours away. In its most basic form, a telestroke system requires a neurologist and attending nurse to have a high-speed Internet connection and videoconferencing capabilities through a phone, laptop, tablet or desktop computer. More sophisticated systems can be integrated with electronic healthcare record (EHR) and practice management system (PMS) applications. Telestroke services allow neurocritical care physicians to talk, ask questions and observe the patient in real time in order to make a diagnosis. Here is one example of how a telestroke consultation might work:
- A patient's family suspects a stroke and calls their primary care physician.
- The physician initiates a web conference with the patient and a remote neurologist.
- The neurologist talks to the patient and conducts an exam over the internet.
- The neurologist orders treatment, such as the administration of tPA (the only FDA-approved treatment for strokes caused by blocked blood vessels) or the transfer of the patient to a more specialized care facility.
- The neurologist works offline with the patient's primary care physician to follow up on patient care.
Currently, there are more than two dozen telestroke networks in the United States. Most are based in large cities and/or university medical centers and help smaller health care facilities stay compliant with requirements set down by the Emergency Medical Treatment and Labor Act (EMTALA). Until recently, one of the biggest impediments to telestroke adoption -- and telemedicine in general -- has been reimbursement for services. Now that the Centers for Medicare & Medicaid Services (CMS) allow reimbursement for telestroke services, its expected that adoption in the United States will increase. | 
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