New web-based system augments HealthAlliance’s stroke care

HealthAlliance Chief Medical Officer Dr. Paul Llobet, right, talks with NeuroCall IT Director Yuriel Infante via high-def video link. (photo by Nicole Terpening)

Officials at HealthAlliance of Hudson Valley say that new technology will help fill gaps in critically needed specialties and save precious minutes when dealing with strokes and other neurological emergencies. The system, introduced in December uses high-definition video and a remote controlled camera that allows doctors to carry out a detailed examination — from anywhere.

“This is not to replace physicians,” said HealthAlliance Chief Medical Officer Dr. Paul Llobet. “This just gives us that added support when we have an emergency that requires immediate attention.”


On a recent afternoon that “emergency” was a simulated stroke attended by third-party neurological services provider NeuroCall. The Florida-based company employs 12 doctors in Florida, New York and Texas to provide “Telestroke” services to hospitals in 15 states. In small exam room, nurse Nadine Poulet is playing the role of a patient, in a hospital bed and hooked up to a vital-signs monitor. A few feet away, on a computer screen is the image of NeuroCall IT Director Yuriel Infante, who will play the role of a neurologist examining a patient displaying symptoms of a stroke. By controlling a 20x zoom high-definition camera mounted over the screen, Infante can take in every detail of the exam while an audio link allows him to give directions to the patient and a nurse at bedside. The camera can zoom in close enough to get a detailed image of Poulet’s pupils before pulling back, rotating and focusing in on the monitor displaying her vital signs.

In a real emergency, a NeuroCall physician would also have instant access to lab reports, medical imaging and patient history. Taken together with the results of the exam, the doctor would then form a diagnosis and a plan of action. The technology also allows the specialist to put in an order for anything from clot-busting medication to emergency surgery.

“The Internet is very robust,” said Infante. “It allows us to have real-time communication in high-definition.”

The off-site physicians of NeuroCall go through the same vetting process and receive the same admitting privileges as doctors who practice at the hospital. They also receive additional training in “telehealth” topics like how to effectively communicate with patients and nursing staff via video link. HealthAlliance officials say the third-party provider can help fill the gap left when specialists are not physically present in the hospital. While a neurologist is on call 24 hours a day, during off hours they may have to be called in from home to examine a patient. That delay can play havoc with stroke victims where physicians have a narrow window to intervene before permanent brain damage sets in. With an average response time of just 12 minutes, NeuroCall physicians can help bridge the staffing gap.

“The intent is always to have boots on the ground,” said Llobet. “But this allows us to have an emergency consult available if the doctor is not in the hospital.”

The Telestroke initiative is part of a broader push by HealthAlliance to introduce similar programs. In part, the move is intended to capitalize on the healthcare network’s — which includes the former Kingston and Benedictine hospitals and Margaretville Regional hospital — affiliation with the Westchester Medical Center Health Network. The affiliation gives HealthAlliance hospitals access to specialists employed at 10 hospitals in Westchester, Orange, Dutchess and Ulster counties. The Kingston-based company also gets access to WMCHealth’s tele-health operations center which provides centralized service for video-linked exams at all 10 hospitals.

Plans call for HealthAlliance to introduce “tele-health” services in critically needed areas like psychiatry, trauma and intensive care in the near future. Unlike the neurological program, these tele-health initiatives will rely on physicians from within the WMCHealth network. HealthAlliance CEO David Scarpino said that the tele-health system would be especially important to filling an urgent need for qualified psychiatric professionals. Scarpino said that a statewide opioid epidemic and locally high rates of mental illness and behavioral health issues had strained psychiatric resources to the limit.

“Westchester has solved the dilemma of hiring psychiatrists,” said Scarpino, “by linking the community with scarce resources using technology.”