Appl Clin Inform 2018; 09(01): 089-098
DOI: 10.1055/s-0037-1621704
Research Article
Schattauer GmbH Stuttgart

Clinical Information Systems Integration in New York City's First Mobile Stroke Unit

Benjamin R. Kummer
Michael P. Lerario
Babak B. Navi
Adam C. Ganzman
Daniel Ribaudo
Saad A. Mir
Sammy Pishanidar
Tim Lekic
Olajide Williams
Hooman Kamel
Randolph S. Marshall
George Hripcsak
Mitchell S.V. Elkind
Matthew E. Fink
Further Information

Publication History

25 July 2017

12 December 2017

Publication Date:
07 February 2018 (online)


Background Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied.

Objective The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts.

Methods NYP's MSU was staffed by two paramedics, one radiology technologist, and a vascular neurologist. The unit was equipped with four laptop computers and networking infrastructure enabling all staff to access the hospital intranet and clinical applications during operating hours. A telephone-based registration procedure registered patients from the field into our admit/discharge/transfer system, which interfaced with the institutional electronic health record (EHR). We developed and implemented a computerized physician order entry set in our EHR with prefilled values to permit quick ordering of medications, imaging, and laboratory testing. We also developed and implemented a structured clinician note to facilitate care documentation and clinical data extraction.

Results Our MSU began operating on October 3, 2016. As of April 27, 2017, the MSU transported 49 patients, of whom 16 received tissue plasminogen activator (t-PA). Zero technical problems impacting patient care were reported around registration, order entry, or intranet access. Two onboard network failures occurred, resulting in computed tomography scanner malfunctions, although no patients became ineligible for time-sensitive treatment as a result. Thirteen (26.5%) clinical notes contained at least one incomplete time field.

Conclusion The main technical challenges encountered during the integration of our hospital's clinical information systems into our MSU were onboard network failures and incomplete clinical documentation. Future studies are necessary to determine whether such integrative efforts improve MSU care quality, and which enhancements to information systems will optimize clinical care and research efforts.

Protection of Human and Animal Subjects

The institutional review boards of Columbia University and Weill Cornell Medical Centers both approved this study.

  • References

  • 1 Benjamin EJ, Blaha MJ, Chiuve SE. , et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 2017; 135 (10) e146-e603
  • 2 Jauch EC, Saver JL, Adams Jr HP. , et al; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (03) 870-947
  • 3 Ruff IM, Ali SF, Goldstein JN. , et al. Improving door-to-needle times: a single center validation of the target stroke hypothesis. Stroke 2014; 45 (02) 504-508
  • 4 Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 2012; 79 (04) 306-313
  • 5 Evenson KR, Foraker RE, Morris DL, Rosamond WD. A comprehensive review of prehospital and in-hospital delay times in acute stroke care. Int J Stroke 2009; 4 (03) 187-199
  • 6 Gladstone DJ, Rodan LH, Sahlas DJ. , et al. A citywide prehospital protocol increases access to stroke thrombolysis in Toronto. Stroke 2009; 40 (12) 3841-3844
  • 7 Lin CB, Peterson ED, Smith EE. , et al. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circ Cardiovasc Qual Outcomes 2012; 5 (04) 514-522
  • 8 Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol 2013; 12 (06) 585-596
  • 9 Fassbender K, Grotta JC, Walter S, Grunwald IQ, Ragoschke-Schumm A, Saver JL. Mobile stroke units for prehospital thrombolysis, triage, and beyond: benefits and challenges. Lancet Neurol 2017; 16 (03) 227-237
  • 10 Ebinger M, Winter B, Wendt M. , et al; STEMO Consortium. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 2014; 311 (16) 1622-1631
  • 11 Weber JE, Ebinger M, Rozanski M. , et al; STEMO-Consortium. Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study. Neurology 2013; 80 (02) 163-168
  • 12 Kummer BR, Lerario MP, Ganzman AC. , et al. Establishing the First Mobile Stroke Unit in New York City. International Stroke Conference; 2/22/2017; Houston, Texas, USA
  • 13 King LHK, Dragan KL, Driver CR. , et al. Manhattan Community District 8: Upper East Side. Vol. 8, Issue 59. New York, NY, USA: New York City Department of Health and Mental Hygiene; 2015: 1-16
  • 14 Citydata. Carthage, IL: Advameg, Inc. c 2017. Upper East Side (UES) neighborhood in New York, New York (NY), 10021, 10028, 10128 detailed profile. Available at: . Accessed July 15, 2017
  • 15 Bleiwas KB, DiNapoli TP. An Economic Snapshot of Washington Heights and Inwood, Report 2–2016. New York: Office of the New York State Comptroller, New York City Public Information Office. 2015. Available at: . Accessed July 15, 2017
  • 16 Fonarow GC, Smith EE, Saver JL. , et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association's Target: stroke initiative. Stroke 2011; 42 (10) 2983-2989