Sioux Falls, S.D.-based Avera Health’s use of telehealth services illustrates how necessity is the mother of innovation.

The integrated delivery system turned to telehealth 25 years ago to bolster recruitment and retention of physicians in the more rurally remote regions it served.

At the time, physicians suffered from quick burnout, lacked colleagues for collaboration and “were feeling highly stressed over always being on call,” says Avera e-CARE CEO Danna Larson. “They were excellent providers, but they needed the support that they would have if they were practicing in a more densely populated area.”  

To give them peer support, Avera Health built the technology infrastructure to connect rural health care providers in the five Midwest states it served to its Sioux Falls headquarters.

Today, the health system’s Avera e-CARE supports more than 300 small and rural providers in 15 states. Other e-CARE partners include long-term care facilities, schools and prisons.

Avera e-CARE allows critical access hospitals and other rural hospitals to leverage the expertise gathered in a virtual hospital – the “e-hub” located at Avera’s Sioux Falls headquarters.

From the 30,000 square foot hub, Avera e-CARE physicians monitor patients in intensive care units hundreds of miles away. A pharmacist can recommend drugs to providers in rural areas that may lack a resident pharmacist. Caregivers in a rurally remote hospital can press a button and in 30 seconds or less be connected to an Avera e-CARE emergency physician and nurse who use a high-definition camera and other diagnostic equipment to monitor patients, give advice and document everything the on-site practitioners are doing to save their lives.

 “We started in five states, but word spread that this was a wonderful tool for improving the quality of life, saving lives and saving physicians for rural areas,” Larson says.

The program took a big leap forward in 2007, when the Leona M. and Harry B. Helmsley Charitable Trust awarded an $11.5 million grant to expand the services.

Larson says the telehealth services are a crucial lifeline in many rural communities, helping to address workforce shortages and reduce the burden on patients who might otherwise need to travel long distances for specialty care. It also has allowed rural hospitals to outsource diagnostic and other services and helped reduce providers’ sense of isolation and stress, she says. 

And Larson says the reduction in patient transfers and transportation costs have saved hundreds of millions of health care dollars since the program’s inception.   

Some 100 rural hospitals have signed up for its “e-Pharmacy” service. An “e-Pharmacist” can access each hospital member’s electronic medical record to review medication orders, provide discharge instructions and alert staff to changes that may be needed based on lab results.

More than 150 hospitals use the “e-Emergency” service, which helps them handle complex cases.

“As we introduce these services, where you have a group of physicians reaching out to another group of physicians, we realized that medicine is really meant to be delivered in the community,” Larson says. “Providers are trained to work beside each other and with each other, and as they really get to work off of each other’s talents and skill sets, they bring the best to the patient.”

As a result, rural physicians and nurses gain more confidence, and the technology gives them the experience to know which patients they can treat and which need to be transferred to larger facilities for treatment, she says.

And when a critically injured heart attack or stroke patient is transferred, the e-Emergency staff can help get it done quickly. While the on-site ED staff cares for the patient, the Avera e-CARE nurse can be on the phone with the ambulance service and the destination hospital coordinating the transfer. 

Avera e-CARE “is built on trust and mutual respect among providers,” Larson says. “We become an extension of the local health care team.”

She observes that rural hospitals are their communities’ health care safety net and economic anchor. Helping to ensure the viability of rural hospitals and to keep rural patients closer to home boosts small-town economics, she says.

“Telehealth is changing the landscape for rural health care,” Larson says. “It is very rewarding to know you are part of the vehicle that is making that happen.” 

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