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

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	Information governance Patient confidentiality, consent, privacy, and recording Documentation of consultation Accountability Liability, indemnity, legal cover Staff responsibilities Competency assessment Consultant job planning adjustment and payment Clinical quality requirements and standards Administration and evaluation standards Monitoring processes
	*Risk assessment for telestroke*	*Equality and diversity impact assessment*
	*Privacy impact assessment*	*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*	*Medical Directors*
	*Operational Managers*
	*Contracts for telestroke*
	*Collaborative commissioning agreement (Primary Care Trusts)*	*Consortium agreement (Hospital Trusts)*
Agree financing and reimbursement procedures for telestroke	Specify and document agreements on initial and recurrent funding for: equipment and installation training

Lessons learned from the case study:

Developing governance procedures for telestroke

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*	Value stream mapping
	*Process mapping*
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

Lessons learned from the case study:

Developing shared clinical resources for telestroke

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
Test telestroke equipment and system	Test and streamline data entry requirements Test data transfer times and reliability across 24/7 Assess audio/video quality
Develop system activation, maintenance, and repair routines	Identify telestroke system and software repair standards and processes with provider
	*System activation*	*System maintenance*
	*Troubleshooting*
Pilot telestroke system	*System requirements*	*System walkthrough*
Pilot telestroke system	*Walkthrough action plan*
Develop and test the rota	*Telestroke Administrator job specification*	*Job planning options*

Lessons learned from the case study: