Integration of Real-Time Electronic Health Records and Wireless Technology in a Mobile Stroke Unit


      Background: UCHealth's Mobile Stroke Unit (MSU) at University of Colorado Hospital is an ambulance equipped with a computed tomography (CT) scanner and tele-stroke capabilities that began clinical operation in Aurora, Colorado January 2016. As one of the first MSU's in the United States, it was necessary to design unique and dynamic information technology infrastructure. This includes high-speed cellular connectivity, Health Insurance Portability and Accountability Act compliance, cloud-based and remote access to electronic medical records (EMR), and reliable and rapid image transfer. Here we describe novel technologies incorporated into the MSU. Technological data-handling aspects of the MSU were reviewed. Functions evaluated include wireless connectivity while in transit, EMR access and manipulation in the field, CT with image transfer from the MSU to the hospital's Picture Archiving Communication System (PACS), and video and audio communication for neurological assessment. Methods/Results: The MSU wireless system was designed with redundancy to avoid dropped signals during data transfer. Two separate Internet Protocol destinations with split-tunnel architecture are assigned, for videoconferencing and for EMR data transfer. Brain images acquired in the ambulance CT scanner are transferred initially to an onboard laptop, then via Citrix Receiver to the hospital-based PACS server where they can be viewed in PACS or EMR by the stroke neurologist, neuroradiologist, and other providers. PACS and Radiology Information System are 2 of the XenApps utilized by CT technologists on board the MSU. Discussion/Conclusions: These technologies will serve as a blueprint for development of similar units elsewhere, and as a framework for improvement in this technology.

      Key Words

      Subject Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • et al.
        Heart disease and stroke statistics-2016 update: a report from the american heart association.
        Circulation. 2016; 133: e38-e60
        • Del Zoppo G.J.
        • Saver J.L.
        • Jauch E.C.
        • et al.
        Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association.
        Stroke J Cereb Circ. 2009; 40: 2945-2948
        • Hacke W.
        • Kaste M.
        • Bluhmki E.
        • et al.
        Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.
        N Engl J Med. 2008; 359: 1317-1329
        • Zivin J.A..
        Acute stroke therapy with tissue plasminogen activator (tPA) since it was approved by the U.S. Food and Drug Administration (FDA).
        Ann Neurol. 2009; 66: 6-10
        • Cerejo R.
        • John S.
        • Buletko A.B.
        • et al.
        A mobile stroke treatment unit for field triage of patients for intraarterial revascularization therapy.
        J Neuroimaging Off J Am Soc Neuroimaging. 2015; 25: 940-945
        • California Acute Stroke Pilot Registry I
        Prioritizing interventions to improve rates of thrombolysis for ischemic stroke.
        Neurology. 2005; 64: 654-659
        • Katzan I.L.
        • Hammer M.D.
        • Hixson E.D.
        • et al.
        Utilization of intravenous tissue plasminogen activator for acute ischemic stroke.
        Arch Neurol. 2004; 61: 346-350
        • Walter S.
        • Kostopoulos P.
        • Haass A.
        • et al.
        Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial.
        Lancet Neurol. 2012; 11: 397-404
        • Fassbender K.
        • Walter S.
        • Liu Y.
        • et al.
        Mobile stroke unit" for hyperacute stroke treatment.
        Stroke J Cereb Circ. 2003; 34: e44
        • Belt G.H.
        • Felberg R.A.
        • Rubin J.
        • et al.
        In-transit telemedicine speeds ischemic stroke treatment: preliminary results.
        Stroke J Cereb Circ. 2016; 47: 2413-2415
        • Chapman Smith S.N.
        • Govindarajan P.
        • Padrick M.M.
        • et al.
        A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study.
        Neurol. 2016; 87: 19-26
        • Gonzalez M.A.
        • Hanna N.
        • Rodrigo M.E.
        • et al.
        Reliability of prehospital real-time cellular video phone in assessing the simplified National Institutes Of Health Stroke Scale in patients with acute stroke: a novel telemedicine technology.
        Stroke J Cereb Circ. 2011; 42: 1522-1527
        • Itrat A.
        • Taqui A.
        • Cerejo R.
        • et al.
        Telemedicine in prehospital stroke evaluation and thrombolysis: taking stroke treatment to the doorstep.
        JAMA Neurol. 2016; 73: 162-168
        • Fassbender K.
        • Grotta J.C.
        • Walter S.
        • et al.
        Mobile stroke units for prehospital thrombolysis, triage, and beyond: benefits and challenges.
        Lancet Neurol. 2017; 16: 227-237