1. Needs Assessment

2. System Development

3. Clinical and Operational Implementation

4. Training

5. Evaluation

Case Study

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Section 1: Telestroke Needs Assessment

Guidelines suggest that telemedicine should be adopted to eliminate geographical disparities in care, but there is little guidance on what sort of telemedicine system should be deployed. Multidisciplinary representation from key stakeholder groups should be included from the beginning.1

Research identifies that development of a telestroke system involves a large number of stakeholders across organisational and professional boundaries and suggests that telemedicine system development can be hampered by lack of alignment with strategic vision and existing business processes. Formal collaboration and good communication is needed for the negotiation of complex inter-organisational issues. There needs to be a sustainable, long-term business model for investments, expenses and rewards across participating organisations. 3,4

Other telestroke projects detail the implementation tasks and resources to: Lessons learned from the case study include:
1.1 Develop a business case for telestroke

Procuring a telemedicine system Write a plain language specification and involve Procurement early.

1.2 Develop a service and system specification for telestroke
1.3 Involve key individuals in the telemedicine implementation Developing consensus for telemedicine in stroke Use a Project Manager, and don’t under-estimate the work needed to ensure everyone is involved.
1.4 Formalise communication and agreement for telemedicine implementation

Developing communication routes for telemedicine implementation Actively manage balanced levels of involvement across organisations. Agree roles and responsibilities for communication.

Getting agreement for telemedicine in stroke Formalise job planning agreements early with organisational leads, operational management, and clinicians.

Agreeing the finances for telemedicine in stroke Confirm financial agreements in writing at the outset.

1.1 Develop a business case  

Assessment of need for telestroke should include an assessment of the geography of the area, population need, capability and capacity in both the telestroke provider and the patient referral sites, and organisational/staff interest.2

1.2 Develop a service and system specification  

The telestroke model adopted needs to be suitable for geographical distribution and travel distances, predicted volume of requests, and service capacities.2

Implementation task Detail Example
Developing a business case for telestroke
  • Volume of demand for service, travel distances
  • Existing volume of in-hours Tissue Plasminogen Activator
  • Bypass/transfer policies
Business Case Document
Developing a service specification for telestroke
  • Service requirements
  • Quality standards
  • Governance
  • Contract management and evaluation
Service Specification Document
Developing a system specification for telestroke
  • Technical requirements
  • Costings
System Specification Document

Lessons learned from the case study:

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1.3 Involve key individuals

Efforts to engage all key individuals need to take account of the strategic vision and existing business processes of the participating organisations.3 Enrol support for telestroke from general business functions within the host organisations i.e. IT, R&D, business unit, public relations, etc. 3, 4

Implementation task Detail Example

Identify and involve key individuals the key individuals in telemedicine implementation

a) Identify leadership of the telestroke system
b) Identify clinical leadership for telestroke in each department e.g. emergency departments, ambulance, stroke units, radiology etc
c) Agree responsibilities for:

  • administrative management;
  • equipment purchase, set-up, ownership, warranty, repair;
  • initial and ongoing training;
  • development of operational and technical handbooks;
  • development of clinical documentation;
  • development of evaluation, audit and feedback;
  • Information Technology (IT) management;
  • Storage and access to data

Implementation checklist

Implementation Checklist

Assess stakeholder engagement in telemedicine

Collate name, phone, and email contacts for local and regional leads, such as:

  • Technical
  • Innovation/Implementation
  • Clinical
  • Organisational/Strategic

Assessment of professional group understanding and agreement with the implementation of telestroke, willingness to participate, commitment to training

Implementation Guidance Document
Integrate telestroke with other business functions in the organisation
  • Research and Development (R&D)
  • Information governance/data protection
  • Legal services
  • Clinical audit/data collection
  • Bed managers
  • Portering
  • Purchasing/finance
  • Public relations/external communication
  • Web presence
Implementation Guidance Document

Lessons learned from the case study:

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1.4. Formalise communication and agreement

Good inter-organisational communication routes are needed for complicated issues like contacts, legal agreements, equipment installation, and staff training etc. 3, 4, 7 A newsletter might be a useful mechanism for maintaining communication between sites. 2

Implementation task Detail Example
Arrange formal inter-organisational communication routes for telemedicine implementation

Arrange meetings:

  • strategic
  • operational
  • specific

Telestroke Executive
Group Minutes

Telestroke Executive Group Meeting Minutes

Action plan

Telestroke Executive Group Meeting Action Plan

Facilitate and support informal inter-organisational and inter-disciplinary communication routes

Support effective communication between:

a) staff in different departments such as paramedics, neurology/stroke specialists, emergency room staff, and radiology staff
b) clinical staff in different organisations
c) clinical and technical staff
d) with the public

Telestroke e-Bulletin
Develop publicity and marketing materials for the telestroke launch


Public awareness

Telestroke Poster

Lessons learned from the case study:

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