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Widen the Window, Close the Gap: Revolutionizing Stroke Care in Alaska
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Key Takeaways
- Alaska's vast geography centralizes stroke care in Anchorage, complicating timely interventions due to long transport times.
- The ASC and RapidAI partnership aims to standardize stroke care across Alaska, leveraging AI technology to improve diagnosis and treatment speed.
A partnership between a stroke expert coalition and the technology offered by RapidAI has provided a potential roadmap for improving rural stroke care in remote areas of the United States.
Lucy He, MD, FAANS
Stroke Care in Alaska
Alaska, a state of fewer than 1 million people, is vastly different geographically than any of the other 49 states in America. It is one-fifth the size of the lower 48 states combined, 488 times larger than Rhode Island, 2.5 times larger than Texas, and larger than the next 3 largest states combined. Alaska has 0.93 square miles for each person in the state; by comparison, New York has 0.003 square miles per person.1
With that in mind, it is safe to say the delivery of clinical care, and specifically stroke care, is unique and at many times, challenging. It doesn’t help that stroke is the fifth leading cause of death for Americans and its care needs are extremely time-sensitive. Every minute a stroke goes untreated, 1.9 million brain cells die, leading to more than 3 weeks of lost life.2
Much of the stroke care in Alaska is funneled through Anchorage, where nearly half of the state’s residents live.
"Essentially, all large vessel occlusions, medium vessel occlusions, anybody that’s a stroke thermodynamic candidate, they all have to come to Anchorage to get their intervention," Lucy He, MD, FAANS, told NeurologyLive®. "There’s not the ability and obviously not enough providers to go elsewhere. One of the frustrating things has always been how long it takes to get the patient from the outside hospital to Anchorage for stroke intervention."
He, who moved to Alaska in 2023, serves as a neurosurgeon at Alaska Regional Hospital in Anchorage and as a physician sponsor of the Alaska Stroke Coalition (ASC). The ASC, a recently established nonprofit organization, is made up of a passionate community of hospitals, clinicians, healthcare workers, families, administrators, and emergency services aimed at saving lives and improving stroke care outcomes. He, along with other members of the ASC, were integral pieces in the recent incorporation of a new stroke care system that holds potential in remodeling the landscape of acute stroke management in the state.
In September, the ASC announced its partnership with RapidAI, a technology company, on the “Rapid AK” project, a 3-year initiative focused on advancing health equity for Alaskans affected by stroke. As part of its launch, 6 hospitals across the state were given access to RapidAI’s core stroke imaging and workflow products to help overcome roadblocks associated with rural care.2 At the time, 4 Alaskan hospitals, including He’s, were already leveraging the technology to improve stroke identification and treatment. Their prior exposure and success with the technology platform led to the advancement of this partnership, which has already and will continue to provide more equitable and timely care for residents across the state.
What RapidAI Offers
David Stoffel, MD, MBA
RapidAI is considered a pioneer in artificial intelligence (AI)-aided imaging diagnostics. The company’s platform utilizes AI and machine learning from more than 14 million scans to analyze medical images, helping clinicians make faster and more accurate decisions.3
A key features of the platform includes automated image analysis of CT and MRI scans to identify critical conditions such as hemorrhages or blockages. The platform also provides real-time decision support, is designed to integrate seamlessly with existing hospital systems and workflows, and also helps with data collection for understanding future trends in stroke care and research.4
"It’s been a game-changer in terms of speed and accuracy of diagnosis," David Stoffel, MD, MBA, chief business officer at RapidAI, told NeurologyLive. "This system not only streamlines communication but also gives smaller hospitals access to advanced stroke care without the usual delays."
Dr. He added to Stoffel’s sentiment by noting that the group is seeing early promise. “Stroke treatment timelines are shortening, and it’s allowing us to intervene earlier. In some cases, where minutes matter, RapidAI has been instrumental," she said.
The RapidAI interface allows for visualization and integration with a variety of devices and technologies.
RapidAI’s comprehensive stroke platform includes several different products, including Rapid NCCT, Rapid Hypodensity, Rapid ASPECTS, Rapid CTA, Rapid LVO, Rapid CTP, Rapid MRI, Rapid ICH, Rapid Hyperdensity, Rapid SHD, and AngioFlow by RapidAI. The software is all centrally connected through a phone (and web) app, which provides access to results in minutes from receipt of a scan. Through this app, clinicians can preview source images, have full screen zoom functionality of a scan, and rotate images for axial, coronal, and sagittal views. In addition, the app also has convenient windowing presets, including intracranial, skull, brain, bone, stroke, subdural, and bleed.
In the app, clinicians also have access to a centralized list of patient events, messages, and results. In addition, there is a “Go Notification” that allows for quicker coordination of stroke teams for critical cases. Clinicians may also use in-app calling for quicker communication, as well as integrate electronic health records, which can automatically retrieve the most current patient clinical data. Above all, as a patient is being triaged through RapidAI, the app will build a summary of their journey from prehospital routing, emergency room triage, imaging diagnostics, communication and workflow activation, and outcomes.5
RapidAI's interface displayed on a tablet.
Public health and cost consequences of time delays to stroke treatments, such as endovascular thrombectomy, can be burdensome for a healthcare system. This is especially true in a state like Alaska, where there is nearly 5 times the amount of shoreline as there is coastline. Since its origin, RapidAI software has been involved in more than 400 published pieces of research, some testing its specific effects on certain stroke outcomes while others used it as a tool to conduct research. One notable 2021 study showed that the use of the Rapid Mobile App resulted in a 33-minute reduction in door to groin puncture time (P = .02), 35-minute reduction in door to first pass time (P = .02), and a 37-minute reduction in door to recanalization time (P = .02) in univariate analyses when compared with patients treated pre-app. That study, published in the Journal of NeuroInterventional Surgery, also showed that patients who used the Rapid app had significantly lower National Institutes of Health Stroke Scale scores after procedure and at discharge (P = .03).6
"One of our guiding principles is that we want a patient to be able to walk into any hospital, whether it’s in rural Alaska or downtown Chicago, and receive the best care humanly possible," Stoffel added. "That means being connected with the experts and having access to the best type of decision-making possible. We really feel that RapidAI is the vehicle that can deliver that at equal access for healthcare for anyone across the country."
The Partnership
Kevin Myrick, RN
The foundation of the partnership between the ASC and RapidAI was laid during discussion between the ASC’s leadership and stakeholders familiar with successful stroke care models, particularly the Hawaii Stroke Coalition. Kevin Myrick, RN, a stroke coordinator who relocated from Hawaii, took charge of establishing the ASC. Myrick, who now serves as the director of Trauma and Stroke at the Alaska Regional Hospital, quickly filed the necessary paperwork, marking the coalition’s official formulation.
"When I started talking to Rapid about what other locations were doing, I learned that a statewide stroke coalition in Hawaii had gotten a grant to implement similar technology," He noted. "This highlighted the need for funding to make something like that happen here in Alaska."
To Myrick, Hawaii and Alaska aren’t that different. The remoteness of both states, the lack of access to care outside of the metropolitan hubs, and the respect for the dedicated lands of preserved groups across generations are just a few of the parallels drawn. When he lived in Hawaii, he was a part of building the Hawaii Stroke Coalition in a state where stroke care ranked towards the bottom nationally.
Recognizing the needs and fragmented healthcare system in Alaska, with numerous hospitals acting independent of one another, the coalition aimed to create a unified approach to stroke care. The group moved quickly, forming in a little over 2 weeks. At the time, Myrick had reached out to stroke coordinators at various hospitals, looking to foster collaboration among them to discuss stroke care improvements statewide.
"When we first heard about RapidAI, there was some skepticism. But after seeing how it improves image-sharing and decision-making speed, it was clear this could revolutionize how we handle stroke care, especially in remote areas."
As the coalition explored implementing RapidAI’s technology, they faced financial hurdles, as smaller hospitals were reluctant to invest without guaranteed returns on their investment. Then, the coalition identified external funding from a private family foundation, which enabled them to leverage RapidAI’s technology for 3 years.
A helicopter used to transport patients from remote areas to stroke centers.
Myrick added, "Alaska is unique in terms of healthcare delivery. The vast distances and limited resources mean we need to be creative. RapidAI helps bridge that gap by offering remote hospitals the tools they need to provide first-rate care."
In exchange for the technology, participating hospitals will use the “Get With The Guidelines” database for patients with stroke, ensuring standardized data collection and quality improvement. Get With The Guidelines is a quality improvement initiative by the American Heart Association and American Stroke Association aimed at enhancing care for cardiac and stroke patients. It is based on evidence and guidelines for secondary prevention, helping healthcare providers deliver consistent, guideline-driven treatment.
Data collection was a critical selling point to the partnership, considering there were little to no data captured in the state prior to the technology. At the time he arrived in Alaska, Myrick said that only “3 of the 17 hospitals put data into the registry. So, it looked like Alaska was a pretty healthy state, if not the healthiest state, but we know that’s not true. We know access to care is difficult. In Hawaii, we measured transfers by minutes. In Alaska, we measured transfers by hours."
Integrating Rapid’s Tools Into Clinical Care
Amber Simonetti, RN
As with most new opportunities in life, there is a period of integration and adjustment. The same can be said for the new RapidAI system in a state where, in certain parts, patients would be transferred to nearby hospitals via dogsled or snow machine. It may sound farfetched, but it’s true.
"We’ve seen great momentum in bringing RapidAI into hospitals across Alaska," Amber Simonetti, RN, a chest pain and stroke coordinator at Mat-Su Regional Medical Center in Palmer, Alaska, told NeurologyLive. "The biggest hurdle was helping everyone understand that this technology could work on equipment that may not be state-of-the-art. Each hospital setup is different, so adjustments to the workflow and a lot of trial and error go into figuring out the most efficient process. It’s just a matter of adapting RapidAI to what each hospital already has in place."
The ability to tinker and adjust the RapidAI system to fit the needs of each hospital has been critical for its implementation. For Simonetti and many others, being able to modify the system over time, instead of a fast, all-or-nothing approach, has allowed for more natural adoption and more stress-free, long-term buy in.
"For us, learning how to marry this technology with your clinical observations of your patient, and not relying on all one or all the other [is key]," she added. "We also need to recognize that we need to break down these silos of waiting for each next step before we move along in the process, and understanding that you can run things in parallel, which will improve our patient care."
Building a New Future of Hope
A patient being transported from ambulance to plane for travel to a stroke center.
The partnership between the ASC and RapidAI has infused new life into the stroke system in Alaska, with a promising future ahead. Going forward, the partnership allows for a push for standardization across Alaska’s healthcare facilities, ensuring uniformity in stroke care and reducing the cognitive and physical burden on healthcare providers.
"Fundamentally, what we’re trying to do—and we’re just starting to get there—is to protocolize and automate what happens with stroke patients across the state," He said. "Even if timing or telestroke involvement differs slightly by facility, the goal is for everyone to get the same images, engage early, and act consistently. This reduces the manual labor and fatigue that comes with these cases."
Through RapidAI, the state will be able to generate and leverage more consistent stroke data, an afterthought issue for several years. In addition to the general advantages data collection brings, the hope is that this software may help support clinicians who are seeking federal or state research grants. Above all, the partnership continues to help raise awareness about strokes and allows the ASC to refine selection criteria for interventions.
"Just because we live here doesn’t give us an excuse that we shouldn’t perform excellently," she added. "In fact, I think it provides more of a drive that we should be doing better, because we want to make sure that we give people the best chance of returning back to their baseline in their homes, instead of ending up in a long term care facility."
As the system becomes more widely integrated across the state, the vision of transitioning from reactive to preventive stroke care becomes clearer.
"Eventually we’ll reach a steady state for inpatient stroke cases,” He added. "Then the question becomes: 'What can we do to outpatient to reduce strokes overall?' In an ideal world, I’d love to see fewer stroke interventions because people are having fewer strokes, but that’s a broader issue we need to tackle after we stabilize inpatient protocols and technology."
The state has already begun to see the early progress and success of RapidAI, but for many, the long-term impact lies within the shift in mindset of the entire healthcare system. Simonetti added, “It’s about creating a culture of preparedness and precision."
