1. Needs Assessment

2. System Development

3. Clinical and Operational Implementation

4. Training

5. Evaluation

Case Study

Additional Resources



Contact us


Section 2: Telestroke System Development

Guidelines detail quality standards for technical and clinical systems for telemedicine in stroke, and suggest that organisations should operate under rules and principles governed by contractual agreements, including financial agreements. 1

Research suggests that planners need to assess the compatibility of the telestroke service with existing technical and clinical systems and resources, 2, 3, 4 and develop governance procedures and consensus clinical pathways for telestroke that can be tailored to local circumstance. 3, 4, 10.

Other telestroke projects detail the implementation tasks and resources to: Lessons learned from the case study include:
2.1 Develop governance procedures and funding agreements for telestroke Developing governance procedures for telestroke Address clinicians’ concerns about governance at a strategic level
2.2 Develop shared clinical resources for telestroke Developing shared clinical resources for telestroke Do not underestimate the time it takes to develop and agree standardised policies and paperwork
2.3 Develop and test the telestroke system

Job planning issues and staffing resources for telestroke Evaluate the costs and benefits of involvement in telestroke from the perspective of different stakeholders

Developing a workable rota for telestroke Have contingency plans

Testing the telemedicine equipment and the system Invite the people who can make decisions, prepare a checklist, and document the action plan

2.1 Develop governance procedures and funding agreements for telestroke

Develop governance policies for telestroke to support staff working across organisations, and make institutional arrangements for reimbursement. 3, 4

Implementation task Detail Example
Develop governance procedures for telestroke Governance Policy

Risk assessment for telestroke

Risk assessment for telestroke

Equality and diversity impact assessment

Equality and diversity assessment

Privacy impact assessment

Privacy impact assessment

Risk assessment for telestroke location

Risk assessment for telestroke location

Formalise agreements for telestroke Letters of agreement: Document management support for telestroke from each organisation and stakeholder group

Chief Executives

Letter to Chief Executives

Medical Directors

Letter to Medical Directors

Operational Managers

Letter to Operational Managers

Contracts for telestroke

Collaborative commissioning agreement (Primary Care Trusts)

Collaborative Commissioning Agreement

Consortium agreement (Hospital Trusts)

Consortium Agreement

Agree financing and reimbursement procedures for telestroke

Specify and document agreements on initial and recurrent funding for:

  • equipment and installation
  • training
Service Fee Agreement

Lessons learned from the case study:

top of page

2.2 Develop shared clinical resources for telestroke

Clinical procedures for telestroke need to be harmonised across sites, and tailored to the local circumstance. 10

Implementation task Detail Example
Assess and document existing clinical processes and pathways

Pathway analysis

Thrombolysis Pathway flow diagram

Value stream mapping

Future State Pathway flow diagram

Process mapping

Process Mapping Flow diagram

Assess available clinical, technical and staff resources
  • Availability and quality of the clinical resource
  • Availability and compatibility of existing clinical pathways, procedures and protocols
  • Compatibility of clinical performance data collection across organisations
  • Availability and readiness of technical resource
  • Staff availability and training
Implementation Checklist

JF TM Implementation

Lessons learned from the case study:

top of page

2.3 Develop and test the telestroke system

Formalise telestroke equipment and technology standards to facilitate diffusion; develop system activation and maintenance routines for the telemedicine system. 3, 4, 8. Test the telestroke system function, 5, 6, 7, 8 and the feasibility of the rota. 8 Maintain close communication and working links between clinical and technical staff. 7

Implementation task Detail Example
Design and install the technical telestroke system   Telestroke Network diagram
Test telestroke equipment and system
  • Test and streamline data entry requirements
  • Test data transfer times and reliability across 24/7
  • Assess audio/video quality
Beta Test Schedule
Develop system activation, maintenance, and repair routines Identify telestroke system and software repair standards and processes with provider

System activation

Quick Reference Guide – Telecart Connection

System maintenance

“Quick Reference Guide – Telecart maintenance


Quick Reference Guide – Telecart troubleshooting

Pilot telestroke system

System requirements

Checklist for Successful Implementation

System walkthrough

System Walkthrough Checklist

Walkthrough action plan

Walkthrough Action Plan


Develop and test the rota

Telestroke Administrator job specification

Telestroke Administrator Job Description

Job planning options

Job Planning Options

Lessons learned from the case study:

top of page