International Journal of Telemedicine and Applications physician for treating patients in Arizona although they are expected to consult a physician whenever they believe the situation warrants it. 6. Conclusion This preliminary study was limited, principally by size (10 consultations) and the lack of a direct comparison arm. Nonetheless, the study was the ﬁrst to demonstrate that a VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to rural emergency departments within an established hub and spoke network. Future larger studies on this topic should be designed to compare timeliness, accuracy, decision making, eﬀectiveness, short and long term clinical outcomes, and cost of the VN-NP versus vascular neurologist-only model for acute stroke care in rural community settings. 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