ISC 2026 | Lessons learned from the first eight years of the Manitoba TeleStroke Program

I don’t know if your viewers will know where Manitoba is. Manitoba is the central province in Canada. And over the first eight years of the Manitoba Telestroke Program, we have learned several important lessons about access, equity, and system transformation in stroke care. First, telemedicine works. We have demonstrated that high-quality, time-sensitive stroke expertise can be delivered remotely and safely. Patients presenting to the rural and northern hospitals were able to receive the rapid specialist assessment, imaging interpretation, and treatment decisions in real time. This translated into increased use of thrombolysis, faster decision making, more patients receiving appropriate acute stroke care closer to home. Second, the geography should not determine outcome. Manitoba, and in other words, the whole of Canada and many parts of the world, has vast rural and remote regions, including many indigenous communities in Canada. Before telestroke, patients often faced long transport delays before specialist input. The program significantly reduced those inequities by bringing expertise virtually to the bedside, rather than moving every patient hundreds of kilometers, if not sometimes thousands of kilometers. Third, system organization matters as much as technology. Telestroke is not just a video link. It requires standardized protocols, local team training, imaging workflows, and ongoing quality monitoring. Building strong partnerships with rural physicians, nurses, paramedics has been critical to success. Trust and collaboration drove the adaptation of this technology in our province. Fourth, data collection and continuous evaluation are essential. Over eight years, we have refined the door-to-needle time, improved imaging turnaround, strengthened the transfer pathway for patients needing thrombectomy, and the program has evolved based on the performance metrics and feedback from the participating sites and participating healthcare professionals. Finally, sustainability requires investment in people. Technology is important, but dedicated coordinators, stroke neurologists, and engaged rural teams are what make the system more resilient. Overall, the Manitoba telestroke experience shows that telehealth can meaningfully reduce the disparities in stroke care, improve outcomes, and build a more integrated provincial system. It’s a model that demonstrates how innovation, when thoughtfully implemented in an organized manner, can actually narrow the urban-rural gap in critical care.

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