A Conversation with Dr. Robert Adams, Director of the REACH Stroke Network at MUSC

LowcountryBizSC:

You are fairly new to South Carolina. How and why did you come to MUSC?

Dr. Robert Adams:
Lucky I guess! (Chuckles) Seriously, I had the unique opportunity to pursue my passion, which is the prevention and treatment of stroke, at the Medical University of South Carolina (MUSC), one of the oldest medical schools in the country and rapidly becoming one of the best. I was recruited to MUSC as the endowed chair for the Stroke Center of Economic Excellence (CoEE) supported by Health Sciences South Carolina and by the South Carolina Commission of Higher Education. I’m charged with addressing South Carolina’s alarming stroke rate with the goal of improving public health, and in the process, contributing to the development of the state’s economy

LowcountryBizSC:
Why is stroke a Center of Economic Excellence?

Dr. Robert Adams:
When the General Assembly created the CoEE program in 2002, they saw research as a means of transforming our state’s economy. Of course, job creation was and is a priority of the program. The Centers are also charged with creating products and services that can be commercialized. In my case, the Stroke Center offers a novel approach to the evaluation and treatment of acute stroke using software, the Internet and clinical expertise. The economic impact is this: if we can treat stroke patients within a critical time period and with the right medicines, the patient has a better chance of returning to his or her previous health without permanent damage. So instead of people who are bedridden and on disability for the rest of their lives, we hope to return stroke patients to a fully functioning life at home and on the job. With South Carolina’s stroke rates, the economic impact is significant.

We also intend to innovate the way stroke is treated. One example is the very large National Institutes of Health (NIH) grant, called SAMMPRIS, awarded to Marc Chimowitz of MUSC, also an endowed chair in the Stroke Center. This $25 million grant administered through MUSC involves 60 sites in the United States and created jobs at MUSC. It is a clinical trial of the kind that the FDA looks at prior to approval of drugs or devices. We also plan to innovate recovery from stroke and the devices and techniques used in this process.

LowcountryBizSC:
What is the REACH MUSC Stroke Network?

Dr. Robert Adams:
The REACH MUSC Stroke Network is the first hub in a statewide telemedicine network that will one day include the Greenville Hospital System University Medical Center and Palmetto Health working with the USC School of Medicine. Using the Stroke Center’s web-enabled technology platform, REACH MUSC puts an expert in stroke care into the emergency departments of partner hospitals in about 10 minutes. The goal is to provide immediate access to expert stroke care 24 hours a day, seven days a week to all South Carolinians regardless of where they live. Right now, REACH MUSC is the first expert stroke center to go live in the REACH Stroke Network. For the last 18 months, we’ve been actively enrolling hospitals across the state into the network and saving lives.

LowcountryBizSC:
Why does South Carolina need the REACH Stroke Network?

Dr. Robert Adams:
It’s simple—our citizens are dying at unacceptably high rates. For 50 years, South Carolina has been among the highest for stroke death rate in the United States. It’s the third leading cause of death in our state behind heart disease and cancer. If you’re African-American, watch out! The stroke-related death rate of African Americans is 60 percent higher than whites. While there are things we can and must do to prevent stroke, the first step is to dramatically increase access to expert stroke care in our state’s rural communities. That’s what we’re doing with the REACH Stroke Network.

LowcountryBizSC:
How does it work?

Dr. Adams:
People always wish they could be in two places at one time. With the REACH MUSC Stroke Network, that’s exactly what happens with MUSC’s stroke experts. We’re in Charleston, but when we get the call, we’re also in hospital emergency rooms around the state. Here’s how it works. When a stroke patient comes to the emergency room of a REACH MUSC Stroke Network hospital, the ER physician orders radiology imaging with a CT scan and then notifies REACH MUSC. Within 10 minutes of the call, a REACH MUSC stroke expert is online with full, two-way video and audio communication with the ER. This allows the REACH MUSC stroke expert to consult with the ER physician, talk to the patient and family members, and review test results, especially the brain scan. After a thorough evaluation, the REACH MUSC stroke expert makes a recommendation regarding treatment, especially as to whether tPA, the clot-buster drug, should be administered and also whether it is necessary to transfer the patient to MUSC for advanced treatment.

LowcountryBizSC:
What hospitals are participating in the network?

Dr. Adams:
We have been very pleased with how quickly hospitals have embraced this opportunity to enhance their emergency stroke care capabilities. Right now there are six hospitals partnering with REACH MUSC. They are Georgetown Memorial Hospital, Grand Strand Regional Medical Center, Marion County Medical Center, McLeod Regional Medical Center (Florence), Waccamaw Community Hospital, and Williamsburg Regional Hospital. We’re also discussing contracts with a number of other sites.

LowcountryBizSC:
Some of these hospitals don’t appear to be small or rural.

Dr. Adams:
You’re right—McLeod in Florence is an urban hospital, but they’re also affected by a shortage of specialty physicians. With REACH MUSC, they can provide expert stroke care 24/7. Within ten minutes of a stroke patient arriving at their emergency room (ER), they’ve got an MUSC neurologist live via the Internet consulting with the ER physician, patient and family members. It could be 2 a.m. on a Sunday morning and the REACH stroke expert is there. That’s a huge benefit for any hospital regardless of size or location.

LowcountryBizSC:
What benefits have we seen since REACH MUSC began?

Dr. Adams:
Since REACH MUSC began in May 2008, we have provided more than 200 consults on emergency stroke patients with our partner hospitals. Nearly a third of these patients were diagnosed with an ischemic stroke and given tPA, the clot-buster drug. Although tPA is proven to save lives and reduce permanent damage to stroke patients, its usage in South Carolina was less than two percent prior to the REACH Stroke Network because you need an expert diagnosis before administering it. By improving access to expert stroke care in rural South Carolina, we have seen an increase in the usage of tPA, which should translate into more victims of stroke surviving, returning home and perhaps work, and enjoying life without disability.

LowcountryBizSC: 
Can the REACH Stroke Network web-based platform be used for other medical specialties?

Dr. Adams:
Absolutely! Neurology is just one medical specialty in high demand and short supply, particularly in South Carolina’s small and rural communities. People are recognizing that web-enabled telemedicine is a way to leverage the intellectual resources of specialists to augment local doctors and help more patients in need of specialized care. In fact, MUSC has recently been awarded a grant from the National Institutes of Health (NIH) to develop expert trauma and sepsis care services to rural South Carolina hospitals using the REACH platform. Five hospitals are expected to participate and partner with MUSC in this project. This is great news for all South Carolinians. We’re also looking at ways to make the REACH platform better by greater data interconnectivity with each REACH partner, with the goal of adding value to the system and creating a new business in South Carolina to work with REACH Call, Inc., the Georgia company that supplies the platform.

LowcountryBizSC:
How will healthcare reform affect your work with REACH?

Dr. Robert Adams:

With or without healthcare reform, our healthcare system is on the cusp of tremendous change as we deal with a growing senior population, a shortage of specialty physicians, a large uninsured population, and limited resources.