Eric Roath, 44, lives in Bethel, near the southeastern corner of Oklahoma. He's a logger, husband, father to three boys, and loves to fish and show pigs. He thought he was too young to have a stroke – until Sept. 8 of last year.
Roath felt fine as he went to work, but he began feeling hot and nauseous, and experienced blurry vision.
"After that, I just don't really remember much," Roath said.
His boss drove him an hour and a half to McCurtain Memorial Hospital in Idabel, which doesn't have a neurologist. But he was still assessed by one.
That's because of its partnership with OU Health's telestroke program, which allowed a neurologist in Oklahoma City to evaluate him and recommend clot-busting medication. Then, he was airlifted to the OU Health campus.
If 30 more minutes had passed, Roath said the intervention wouldn't have worked.
"All the symptoms I had – I couldn't hardly talk, couldn't hardly walk, hardly no use on my left side – I guess that would have kind of hung around," Roath said. "But now I'm pretty much back to normal."
"They pretty much saved my bacon."
Nearly 40% of Oklahomans live in rural areas, where stroke mortality rates are higher and access to specialized care is limited. Minutes can mean the difference between recovery and disability. Oklahoma officials are investing in telemedicine to help rural hospitals better evaluate and care for stroke patients.
Partnering with rural communities on stroke care
OU Health's telestroke program was established in 2021, starting with a few sites, like the one in Idabel. A couple of years later, an $861,190 grant from the U.S. Department of Agriculture kick-started its rural telestroke network.
OU Health is using it to station telestroke carts equipped with a camera and computer screen at 23 rural facilities. It's halfway through and has until next summer to spend the remaining money.
Dr. Shyian Jen is the program's medical director. She said facilities can administer clot-busting medication on their own. According to American Heart Association guidelines, the time window for providing it is within 4.5 hours of symptom onset. Patients who receive this medication have a higher likelihood of only experiencing minor symptoms.
Jen said rural hospitals without telestroke services would call OU or a different system to talk with a neurologist over the phone. But this process was limited because recommending clot-busting medication involves a rapid review of imaging to ensure the patient doesn't have a bleed, which could be worsened by it.
"Rural hospitals would rely on having a radiologist read it locally, and oftentimes they don't have that arrangement. They don't have a 24-7 radiologist to read that," Jen said. "In that situation, a particular patient showing up in a hospital that did not have the services may have delayed treatment or moved outside of the time window where they can't get treatment."
She said the telestroke program helps rural facilities connect with OU Health's Comprehensive Stroke Center team any time a patient with stroke-like symptoms enters their emergency room.
Rural providers run labs, start IVs and take patients for a CAT scan. Then, they notify OU's transfer center, and the neurologist on call is paged. They log into a telehealth platform, where they can view patient images in real time.
From there, they log into the telestroke cart and use it to guide patient evaluations and treatment management. If a patient needs more care, OU Health can help facilitate it. But if they don't, OU assists hospitals in keeping patients local. Jen said half of the patients served through this program have stayed in their local facility, thereby reducing unnecessary transfers.
Lane Manginell, the chief operating officer for McCurtain Memorial Hospital, said the critical access hospital in Idabel serves one of the largest counties by area in Oklahoma.
It can be difficult in medical emergencies, especially when that county includes tourist destinations like Broken Bow, where traffic adds to travel time. He said their emergency department sees around 15,000 patients annually.
Manginell said it takes the entire organization to implement new service lines. McCurtain Memorial heavily invested in its IT infrastructure to expand telehealth in the facility, which was built in 1974 and not designed for it. He said that was challenging, but partnerships like this are crucial for patient outcomes.
"We may never be able to support something such as a full-time neurologist or cardiologist here," Manginell said. "... Being able to have those partnerships where patients can still get that care here locally has been critical."
OU Health Virtual Care Program Manager Chelsea Yearout said it's also important to ensure the partnership fits the facility. OU meets with them to learn their current workflows and see how they fit in. They provide education on stroke care and the telestroke cart to staff and offer to come to community events.
"We don't want to come in and put an OU name on something and try to make it ours in a different location," Yearout said. "We really want to partner with the rural communities, learn what their needs are and integrate our telestroke workflow into the work they're already doing."
Expanding telestroke through federal, state dollars
OU Health and other partners are working to make a difference in other rural communities by expanding telestroke. OU became a subrecipient of $499,555 in Rural Health Transformation Program funds this year. The federal grant program is awarding billions of dollars to states to improve health care in rural communities.
Dr. Jen said OU plans to expand beyond 23 sites to 30 total. She added that Oklahoma's Rural Health Transformation Program telestroke projects are focused on acute stroke-ready certification and assisting hospitals in achieving a certain level of care.
The Oklahoma Hospital Association is also receiving $157,500 annually over three years from TSET to grow telestroke support in Oklahoma, benefiting 20 rural hospitals in the state.
Greg Martin, the association's vice president of shared services and partner development, said these investments have worked in other states, like Arkansas. A statewide initiative that began in 2008 through the University of Arkansas for Medical Sciences now digitally connects over 60 hospitals across the state with stroke specialists.
Over 94% of all Arkansans are within a 30-minute drive of a stroke-ready hospital. The program resulted in $59 million in cost savings for stroke care in 2022 and reduced the state's stroke mortality rate.
"There's so many pressures on not only hospitals, but to the state budget," Martin said. "If there's anything that we can do that, in the course of due diligence of taking care of patients, not only helps the patients, but saves the system as a whole and the state as a whole money, that's a great thing."
Martin said he hopes the association can offer materials to hospitals at no cost so they can raise awareness about strokes. Education, he said, has been at the heart of Arkansas' success.
"What happened over the years is more and more people became aware of the signs and symptoms, and that drove people to the hospitals that have telestroke, and they were able to have quick, early interventions," Martin said. "And that's one of the key things that changed their state."
Back in Bethel, Roath said Sept. 8 was a blessing in disguise. He's managed his blood sugar, and now he doesn't take insulin. It was also a gift for his family, who now have a future with their husband and dad.
"They was all real happy. I mean, it could have ended a lot different," Roath said.
"Every rural community ought to have something like this."
