Customer Interview 1
Appendix B: Customer Interview Reports
Customer Interview 1
For this interview, we discussed the practicality and market need for a tool to aid in the remote
diagnosis of strokes via telemedicine. The tool is a wearable device worn on the face that allows
a specialist to remotely assess the visual fields of a patient.
Mary Britton | Stroke Coordinator, Promedica Health System
Mary Britton, the stroke coordinator for the regional NW Ohio area, was chosen for this
interview due to her extensive knowledge on the topic of strokes and her familiarity with the
need for a swift diagnosis. She also has experience with a wide variety of stroke and post-stroke
care techniques. Her experience and perspective will be helpful to us for finding a niche for the
product within the diagnosis, analysis, and recovery process of stroke patients.
After explaining the utility of the device to Mary, she offered her opinions on how the
device could be implemented within the stroke diagnosis process. She stated that the use of
telemedicine for the diagnosis of strokes is growing tremendously. Currently, EMT’s in the field
are using iPads to connect with specialists from the ambulance. They are able to communicate
with the neurologist and ask questions as well as take instructions to help diagnose the patient on
the way to the hospital. There is even a mobile stroke unit that includes specially-trained EMT’s
and an ambulance with a working CT scanner inside. These tools have improved the time to
diagnosis and time to treatment for severe or “acute” stroke cases. In general, if the EMS think
the patient is experiencing a stroke, preparations are made at the hospital while the patient is in
transport to allow them to be diagnosed and treated as quickly as possible. This includes
prepping the CT scanner and IV access for the incoming patient. In almost all cases that an EMT
suspects a stroke, the patient undergoes a CT scan. The CT scan is a much more reliable test that
helps doctors determine if the stroke is Ischemic or Hemorrhagic. Ischemic means there is a
blockage in the brain, hemorrhagic means there is bleeding in the brain. After the CT Scan
concludes that the stroke is not Hemorrhagic, and the patient’s last known normal was less than 4
hours before diagnosis, the patient is given TPA, a clot-busting injection. This breaks up the clot
that is causing the Ischemic Stroke. This distinction is important as TPA could be life threatening
to a hemorrhagic stroke victim.
There is a standard field diagnosis technique, called the National Institute of Health
(NIH) Stroke Scale, EMT’s use this technique to preliminarily diagnose the severity of the stroke
in the patient. This stroke assessment works well enough for severe strokes and yields a strong
confidence that a stroke is occurring. Mary indicated that since this test reliably indicates a stroke
is occurring, the Telestroke Goggles would not improve this process. She did explain to us that a
more feasible and useful application for the Telestroke Goggles: the case of the minor stroke.
Often times, if a patient is not exhibiting the symptoms of a severe stroke, they are not
immediately transported to Toledo hospital and are monitored for 23 hours in the rural clinic.
Since it is not as easy to detect if the patient is having a minor stroke, the tool can be useful to
get a more accurate depiction of the visual field loss of the patient. At these clinics there are no
specialists available so the telemedicine aspect of the device will allow nurses to apply the
device and a specialist can carry out the test remotely. Mary also said the device could be used
post-treatment to determine if the visual field loss has improved in patients. The minor stroke
case can often be confused for post-migraine, post-seizure, or encephalopathic symptoms.
Patients can even misleadingly exhibit stroke-like symptoms if they have a psychological
condition called conversion disorder. Having this device at the fingertips of these clinics will
allow the minor stroke cases to be easily sorted out from the false positives.
Overall, Mary’s comments helped us realign our market focus towards the minor stroke
case. She did not have any improvement comments on the device itself. She believed the
principle diagnosis method of the device to be correct and that the device would serve a market
need in a rural clinical setting.