Telemedicine in stroke: organizing a network--rationale and baseline principles.

Telestroke is the specific term used for the application of telemedicine in stroke. It is a consultative modality that facilitates care of patients with acute stroke at underserved hospitals by specialists at stroke centers and can play a vital role in minimizing the overall medicosocial impact of stroke. Telestroke should not be viewed as a new form of stroke therapy, rather as a means of supporting the increased delivery of evidenced-based medicine in stroke. The design and implementation of a hub-and-spoke telestroke network are complex and require state-of-the-art technology and close, organized collaboration between healthcare professionals if they are to be achieved. Telestroke is becoming part of clinical practice in some regions. It provides rapid access to specialized treatment and it could also potentially lead to major improvements in basic on-site management. Telemedicine is also being used for secondary prevention, rehabilitation, education and long-term stroke care. However, for progress to continue and in order to ensure the long-term sustainability of telestroke, various medicolegal, economic and market issues need to be resolved.