1. Needs Assessment

2. System Development

3. Clinical and Operational Implementation

4. Training

5. Evaluation

Case Study

Additional Resources



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  1. Schwamm LH, Audebert HJ, Amarenco P, Chumbler NR, Frankel MR, George MG, Gorelick PB, Horton KB, Markku K, Lacklnad DT, Levine SR, Meyer BC, Meyers PM, Patterson V, Stranne SK, White CJ, on benhalf of the American Heart Association Stroke Council; Council on Epidemiology and Prevention; Interdisciplinary Council on Peripheral Vascular Disease; and Council on Cardiovascular Radiology and Intervention. Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke. 2009; 40: 2635-60

Research on specific telestroke projects


  1. Miley M, Demaerschalk MB, Olmstead NL, Kiernan, TJ. (2009) The state of emergency stroke resources and care in rural Arizona: a platform for telemedicine. Telemedicine & E-Health.  15 (7): 691-9


  1. Cho S, Khasanshina EV, Mathiassen L, Hess, DC, Wang S, & Stachura ME. (2007a) An analysis of business issues in a telestroke project.  Journal of Telemedicine & Telecare. 13 (5): 257-62.
  2. Cho S, Mathiassen L. (2007b) The role of industry infrastructure in telehealth innovations: a multi-level analysis of a telestroke program. European Journal of Information Systems. 16: 738-50.


  1. Audebert HJ, Kukla C, Vatankhah B, Gotzler B, Schenkel J, Hofer S, Fürst A, Haberl RL. (2006) Comparison of tissue plasminogen activator administration management between telestroke network hospitals and academic stroke centers: the telemedical pilot project for integrative stroke care in Bavaria/Germany. Stroke. 37: 1822-7
  2. Ickenstein G, Horn M, Schenkel J, Vatankhah B, Bogdahn U, Haberl R & Audebert H. (2005) The use of telemedicine in combination with a new stroke-code box significantly increases t-PA use in rural communities. Neurocritical Care. 3(1):27-32.


  1. LaMonte MP, Bahouth MN, Hu P, Pathan MY, Yarbrough KL, Gunawardane R, Crarey P, & Page W. (2003) Telemedicine for acute stroke: triumphs and pitfalls. Stroke.  34:: 725-8.

East of England

  1. NHS East of England. (2010) Telemedicine for Stroke: An introduction to the Service.


  1. Wiborg A & Widder B. (2003) Teleneurology to improve stroke care in rural areas: The telemedicine in stroke in Swabia (TESS) project.  Stroke. 34:2951-6.

Finnish Network

  1. Tatlisumak T, Soinilia S & Kaste M. (2009) Telestroke networking offers multiple benefits beyond thrombolysis. Cerebrovascular Disease. 27 (Suppl 4):21-7.


  1. Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Thomas RG, Lyden PD (2008a) Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurology. 7: 787-95
  2. Demaerschalk BM, Kiernan TJ, and STARR Investigators. (2010) Vascular neurology nurse practitioner provision of telemedicine consultations. International Journal of Telemedicine and Applications. Article ID 507071
  3. Demaerschalk BM, Bobrow BJ, Kiernan TJ, Aguilar MI, Ingall TJ, Dodick DW, Ward MP, Richemont PC, Brazdys K, Koch TC, Miley ML, Hoffman Snyder CR, Corday DA, Meyer BC; for the StRokE DOC AZ TIME Investigators. (2010) Stroke team remote evaluation using a digital observation camera in Arizona. Stroke. 41: 1251-8

Other systematic reviews of telestroke

  1. Deshpande A, Khoja S, McKibbon A, Rizo C, Jada AR (2008) Telehealth for Acute Stroke Management (Telestroke): systematic review of analytic studies and environmental scan of relevant initiatives. Ottawa, Canadian Agency for Drugs and Technologies in Health.
  2. Price CI, Clement F, Gray J, Donaldson C, Ford GA (2009) Systematic review of stroke thrombolysis service configuration. Expert Review of Neurotherapeutics. 9 (12): 211-33
  3. Demaerschalk BM, Miley ML, Kiernan TE, Bobrow BJ, Corday DA, Wellik KE, Aguilar MI, Ingall TJ, Dodick DW, Brazdys K, Koch TC, Ward MP, Richemont PC, for the STARR Co-investigators. (2009) Stroke telemedicine. Stroke. 84 (1): 53-64
  4. Wu O, Langhorne P. (2006) The challenge of acute-stroke management: does telemedicine offer a solution? International Journal of Stroke. 1: 201-7
  5. Johansson T, Wild C. (2010) Telemedicine in acute stroke management: systematic review. International Journal of Technology Assessment in Health Care. 26 (2): 149-55
  6. Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, Handschu R, Jauch EC, Knight WA, Levine SR, Mayberg M, Meyer BC, Meyers PM, Skalabrin E, Wechsler LR, on behalf of the American Heart Association Stroke Council and the Interdisciplinary Council on Peripheral Vascular Disease. (2009) A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 40: 2616-34