The document discusses a study on using teleconsultation for stroke patients via videoconferencing. Ratings from patients on comfort, ease of use and preference for home teleconsultations were positive. However, clinicians' ratings of acceptability and usefulness were mixed, as lower bandwidth led to lost connections or poor quality affecting examinations. While teleconsultation was feasible with good internet access, unreliable transmission rates were a limitation. Current 3G coverage outside major areas also limits the approach.

1. STROKE TELECONSULTATION Paul McCullagh 1 , Michael Power 2 , Belinda Wroath 2 , Pat Lundy 1 , Mark Beattie 1 , Shumei Zhang 1 1 School of Computing & Mathematics, University of Ulster, UK 2 Ulster Hospital, South Eastern Trust, Northern Ireland, UK

6. Stroke initiatives A&E Consultant Consultant HCP

9. Coverage

11. Broadband Speeds BBC survey, August 2011 South Eastern Trust, Northern Ireland

12. Technical Trials

13. Upload and download data transmission rate changed during a videoconference. This data transmission rate determines the video and audio quality; lost connection some times during a videoconference Variation in Speeds

14. Image quality reduces when the person is moving (compared to static), although the data transmission rates are similar Image Quality

16. Patient Interaction Interaction: History, symptoms, medication, BP, face close up, walking Next appointment The study received a favorable ethical opinion from ORECNI (09/NIR03/84) Any interaction with the patient preserves his/her anonymity and data is stored securely without any patient identifiers All information regarding the consultation process is stored in a secure patient administration system in the hospital Technical information regarding the consultation is held by the university researchers

17. 1 = poor, 2 = ok, 3 = good, 4 = very good, 5 = excellent; Initial Results ID Date Area 3G bandwidth (kbit/s) WiFi Quality From patients From clinicians Patient’s home Hospital Video Audio Comf. Ease Pref. Acce. Usef. Limitations Up. Down. Up. Down. 1 08/06/10 Urban 605 1448 4 5 Yes Yes Yes Yes 3 Slight delay between image/sound. 2 27/07/10 Rural No signal 3 20/10/10 Urban No signal 4 24/11/10 Urban 1448 1256 4 4 Yes Yes Yes Yes 5 Unpredictable coonection 5 09/02/11 Urban 14258 26416 Yes Yes Yes Yes Yes 4 6 14/02/11 Urban 331 1848 4 4 Yes Yes Yes Yes 4 7 31/03/11 Urban No signal 8 Urban 9 16/06/11 Urban 864 3000 4 5 Yes Yes Y/N Yes 4 10 Rural No signal 11 16/06/11 Urban 1474 1112 5 5 Yes Yes Yes Yes 4 Examination possible 12 Urban 13 13/06/11 Urban 1100 4000 4 5 Yes Yes Y/N Yes 4 Lag, jerky 14 Urban 15 21/07/11 Urban 1321 1920 230 390 5 5 Yes Yes Yes Yes 16 26/07/11 Urban 662 1176 1444 1488 4 4 Yes Yes Y/N Yes 5 Signal strength 17 27/07/11 Urban 1471 1032 1172 2168 5 5 Yes Yes Yes Yes 4 Examination possible 18 03/08/11 Urban WiFi 1071 1608 Yes 5 4 Yes Yes Yes Yes 5 Used WiFi. Echo 8152 910 19 20 21 22 23 24

19. Assessment Role Assessment Patient Was the equipment intrusive/acceptable? Were you able to understand hospital consultant? How easy was equipment for communicating/responding to hospital consultant? What was the overall comfort with/acceptability of the procedure? Was there satisfaction with arrangements for the teleconsultation? Preference for teleconsultation as opposed to travelling for a hospital appointment? Primary Care Team What was the acceptability/intrusiveness of equipment? How was communication with hospital consultant? Was there a benefit of consultant availability Were there specific limitations of the teleconsultation process? Any problems arranging the teleconsultation with patient and consultant? Consultant How was the communication with patient? How was the communication with technology team? Did the consultation permit review of patient progress? Were there specific limitations of the teleconsultation process? What were the problems with arrangements? Technical Team Was there a wired Internet/wireless Internet/ in addition to the 3G connection How Easy was it to establish the connection? Were there service interruptions? What was the perceived transmission quality (lag/screen freeze etc.) What were the data transmission bit rates upstream /downstream