A Smartphone Application as a Telemedicine Tool for Stroke Care Management

Neurol Med Chir (Tokyo). 2021 Apr 15;61(4):260-267. doi: 10.2176/nmc.oa.2020-0302. Epub 2021 Mar 12.


Since smartphone applications are revolutionizing telemedicine, a new application specifically for stroke care (JOIN) was designed. Addition of the JOIN smartphone application to the stroke treatment workflow in our hospital was assessed. JOIN has key functions that may improve the care of stroke patients, including the ability to (1) exchange information such as patient data and medical images in real-time throughout the entire process of patient management; (2) track each step of the protocol from door to discharge; and (3) facilitate real-time interaction of all team members via text, audio, and a video chat system. Two periods, 2.7 years before the implementation of JOIN (Pre-JOIN) with 37 patients and 2.2 years after (Post-JOIN) with 54 patients, were compared, and the workflow for all 91 patients who had a cerebral infarction and were treated with tissue plasminogen activator (tPA) and/or thrombectomy between October 2012 and July 2017 was reviewed. There were noticeable reductions in overall patient management time, including times for door-to-imaging, starting tPA treatment, and endovascular intervention with JOIN. Staff members were unanimously satisfied with JOIN, due to the increased efficiency of information exchange and the ability for real-time discussions with different professionals when needed. No significant changes in patient outcomes (as assessed by modified Rankin Scale [mRS] scores) at 3 months and in the total cost for the treatment were observed. A smartphone-based application with the capability of sharing information instantaneously among healthcare professionals facilitated time-sensitive, acute care of ischemic stroke patients.

Keywords: cost-effectiveness; diagnosis procedure combination; information and communications technology; smartphone application; telemedicine.

MeSH terms

  • Brain Ischemia*
  • Humans
  • Smartphone
  • Stroke* / diagnosis
  • Stroke* / therapy
  • Telemedicine*
  • Thrombectomy
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome


  • Tissue Plasminogen Activator