Telemedicine technology allows us to improve patient access to recommended stroke treatments,” says Dr. Ali. UCLA provides round-the-clock support to 18 hospitals in California that do not have the resources and personnel to provide stroke patients with timely assessments and emergency stroke treatments. Initially launched in 2009, the program now provides more than 150 neurology consults each month. “The key is having everyone know what needs to be done during a stroke code,” Dr. Ali explains. “We typically have a program leader at each hospital to help us champion the program and train staff on how to triage potential stroke patients.” Telemedicine is not limited to remote locations. Virtual robot technology is also used to improve efficiency within UCLA Health. “Our intensive-care specialists often have to manage crises 24/7,” says Neil A. Martin, MD, chair of the Department of Neurosurgery. “Using virtual-presence robots, they can examine and manage patients remotely, which eliminates delays in delivering care associated with traveling to the hospital.” Ronald Reagan UCLA Medical Center was the first hospital in the world to introduce remote-presence robots. The robot is approximately 5½ feet tall with a flat-panel computer screen and camera at its head. Physicians can remotely control the robot using a joystick to make rounds at the intensive care unit and have face-to-face discussions with nurses at the bedside. The technology also extends the capability of UCLA specialists to provide consultation and training around the world. “Some patients are more comfortable staying in their own primary-care setting versus going somewhere they don’t know much about,” Dr. Slusser says. “Obesity management is amenable to delivery via telemedicine because it is primarily a counseling intervention.” Each visit involves a physical examination and presentation by the patient’s primary-care physician, followed by consultation with Dr. Slusser, a dietician and psychologist. Patients are referred for physical therapy based on their symptoms and physical exam. “Many co-morbid conditions can get overlooked in obese children, such as poor sleep hygiene and obstructive sleep apnea, that may cause kids to be hyperactive or overly sleepy during the day,” Dr. Slusser says. “Telemedicine allows us to bring our knowledge and expertise as a multidisciplinary team to more patients and then work collaboratively with their primary-care physicians to unveil and address major challenges.” “This technology eliminates geography as a barrier to anyone, anywhere in the world.” Despite its promise, telemedicine still faces implementation challenges. Some hospitals require consulting physicians to be credentialed in the facility where the patient is being treated. Additionally, some insurance payers cover telemedicine services only in rural areas where there are limited facilities available to patients. Dr. Neil Martin, chair of the UCLA Department of Neurosurgery, checks on a patient remotely via an RP-6 mobile robot. “This technology eliminates geography as a barrier to anyone, anywhere in the world,” Dr. Martin says. For some patients, even short distances represent insurmountable barriers to care. UCLA pediatrician Wendy Slusser, MD, uses telemedicine to provide monthly, multidisciplinary childhood-obesity management for low-income patients at the Venice Family Clinic in Los Angeles. She is working to expand the program to include the Los Angeles Unified School District. 5 UCLA Physicians Update