CMMC, affiliates to offer emergency neuro-consults

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LEWISTON — Soon, stroke patients here will be able to see a Massachusetts neurologist — without leaving their Lewiston emergency room.

Central Maine Health Care, the parent organization of Central Maine Medical Center, is partnering with Massachusetts General Hospital to offer two telemedicine programs.

Using streaming video and state-of-the-art scanners, the first will allow Massachusetts General neurologists to diagnose potential stroke patients here, advising whether Lewiston doctors should use a clot-breaking drug that saves some stroke patients when given within three hours of symptoms but could be life-threatening to those whose symptoms are not actually caused by stroke.

The second program also uses streaming video and will allow Massachusetts General neurologists to diagnose and advise in the treatment of patients with other neurological emergencies, such as ongoing seizures or sudden paralysis.

The programs will begin at CMMC in March. They will begin in the spring at Central Maine Health Care’s Rumford Hospital and Bridgton Hospital and at Parkview Adventist Medical Center in Brunswick, where Central Maine Health Care provides administrative services.

The goal: Get emergency patients seen by experts and get them seen fast.  

“We know more and more that when someone’s having a stroke or an acute neurological injury, the saying now is, ‘Time is brain,'” said Alan Verrill, a CMMC hospitalist involved in the telemedicine project.

Central Maine Health Care officials began discussing a telemedicine partnership a year ago. Patients with stroke symptoms arrived at the CMMC emergency room every day. Together, the four hospitals deal with about 450 to 500 stroke patients a year. The hospital group always had neurologists on call in case of emergencies, but it often took those doctors precious time to get to the hospital.

If the hospital group wanted to continue providing good care, Verrill said, “having this resource available became imperative.”

More than 130 miles away, Massachusetts General offered telemedicine. Officials at both hospitals say the match makes sense.

Ten years ago, the time-sensitive, clot-busting drug became a popular way to treat stroke patients, but many ER doctors didn’t have the expertise to recognize which patients could benefit from the drug and which could be hurt by it. They began calling experts at Massachusetts General for advice.

“We began getting phone calls almost literally the month after (the drug) was released,” said Lee Schwamm, vice chairman of Massachusetts General’s neurology department and director of telestroke and acute stroke services.

“The answer was, ‘I would love to help you, but I don’t know enough about the patient. I haven’t verified when it started, I can’t see whether the weakness and the speech problem really make sense and would be explained by a single area of abnormality in the brain. I don’t know if the scan looks like the stroke is early enough, immature enough, to still be treated or whether it’s involved to the point that now it’ll be dangerous and I might actually harm them by giving the drug.'”

But if he could see the patient — even over video — and get a copy of the CT scan, Schwamm thought he might be able to help. Soon after, the hospital started a telemedicine pilot program. A decade later, the program has evolved to serve 27 New England hospitals, including two in southern Maine.   

CMMC and its affiliated hospitals will be the latest in Maine to join the telemedicine programs. Although other U.S. hospitals do telemedicine, Central Maine Health Care officials said they chose Massachusetts General because its neurologists are renowned for their work and are leaders in the field. 

“They are the people that have published the studies and the textbooks,” Verrill said. “The expertise is superior, almost bar none.”

Once the programs are up and running, Central Maine Health Care ER doctors will be able to consult 24 hours a day, seven days a week with one of Massachusetts General’s 15 neurologists when stroke patients and those with other neurological emergencies are admitted to the ER. Central Maine neurologists can also consult with the Massachusetts General doctors to get a second opinion. 

As part of the consultation, patients and their families will talk with a Massachusetts General doctor over live video. During the evaluation, the doctor might ask a Central Maine nurse or doctor to perform basic tests to help in the physical examination. 

For patients, telemedicine will be included in any regular ER bill, just as a traditional visit with an ER doctor. 

In addition to the telemedicine programs, CMMC has added a hospital-based neurologist to staff the hospital five days a week.

Central Maine officials hope the changes — and a coming public education campaign — will encourage patients to go to the ER when they think they may be having a stroke. 

“One of the things we can’t treat is denial,” CMMC spokesman Chuck Gill said.

“People sit home in Maine and stoically kind of wait out a heart attack, wait out a stroke. That doesn’t work,” Gill said. “Calling 911 is so very important because we can have all the technology in the world, but if people are sitting in their homes and not getting here, it doesn’t help them.”

Stroke warning signs:

* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

* Sudden confusion; trouble speaking or understanding.

* Sudden trouble seeing in one or both eyes.

* Sudden trouble walking, dizziness, loss of balance or coordination.

* Sudden, severe headache with no known cause.

Source: American Stroke Association

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