• A huge limitation to effectively managing acute ischemic stroke in rural areas is the frequent lack of access to local experts in vascular neurology.  While most guidelines encourage the use of telemedicine to overcome such barriers, the start up costs of such programs are sometimes prohibitive, particularly for small, rural practices. 
• A recent, small study showed that providers may be able to use the iPhone as a primary or adjunctive tool with telemedicine, to properly diagnose and manage acute stroke.
• The study compared a face-to-face provider's NIH Stroke Scale (NIHSS) interpretation to that of a remote provider using an iPhone with FaceTime software that allows real-time streaming of audio and video.
• Agreement between providers was excellent (intraclass correlation coefficient 0.98); the NIHSS score of the providers did not differ by more than 1 point in 17 of the 20 cases; in only one category - ataxia - was agreement poor.
• TAKE HOME POINT:  Streaming real-time video technology may offer an effective and economically feasible alternative to suboptimal acute stroke care in rural areas or an alternative/adjunct to pure telemedicine programs.  (This is not an advertisement or endorsement for the iPhone.)

References

• Anderson E, et al.  Remote Assessment of Stroke Using the iPhone 4. Journal of Stroke and Cerebrovascular Diseases 2011.
• Neale T.  iPhone Puts Stroke Patients, Docs Face to Face. MedPage Today.  November 2011. Retrieved from:  http://www.medpagetoday.com/Cardiology/Strokes/29410?utm_source=cardiodaily&utm_medium=email&utm_content=aha&utm_campaign=11-02-11&eun=g%%aha_list_id%%d3r&userid=%%dokn%%&email=%%email%%.