Hospitals with an emergency department
General acute care, critical access, VA and military hospitals that run an emergency department. Every one of them receives suspected stroke patients and has to decide fast whether to treat, transfer or send to the angio suite. This is the outer edge of the stroke market.
Who decides: the Director of Radiology or Imaging Services owns the imaging stack, and the chief of neuroradiology owns how perfusion is read. Imaging informatics decides whether new software can sit on the scanner and viewer the hospital already runs. Many of these hospitals already run an AI or perfusion tool on the stroke pathway, so the first question is usually what happens to the tool already there, before the committee ever sees it.
Who signs it off: the value analysis committee, with IT security review, at most systems. At a critical access hospital the same decision often sits with the tele-stroke partner rather than the hospital itself.