Speakers
• Mike Deyo
Certified PA, Madison Lutheran Home, Madison, MN
• Scott Larson
CEO, Madison Lutheran Home, Madison, MN
• Mandy Bell
eCARE Development Director, Avera Health
Avera
• Avera is a regional partnership of health
professionals who share support services
to maintain excellent care at more than
300 locations in eastern South Dakota and
surrounding states.
• Avera’s roots stretch back to the frontier
medicine of the Benedictine and
Presentation Sisters, who began providing
health care in Dakota Territory in 1897.
Current Challenges in Rural
Health Care
• Workforce shortages
• Geographic isolation
• Diminishing community economics
• Low healthcare margins
• Difficulty recruiting physicians
• Increasing dependence on specialists and
expensive technologies
• Demand for quality
Avera eCARE™
• Acts as umbrella for telehealth and health information
technology
• Maintains or improves access to quality care
• Addresses needs of rural patients and facilities
• Provides support to rural workforce
• Covers the continuum of care working towards a virtual
hospital
• Bundles services to gain efficiencies and raise care
quality
Avera eCARE™ Overview
eCARE
eConsult
Avera eICU®
CARE™
eEmergency
&
eStroke
ePharmacy
eNursery
eUrgent Care
& eLTC
Avera eCARE™ Overview
eCARE
eConsult
Avera eICU®
CARE™
eEmergency
&
eStroke
ePharmacy
eNursery
eUrgent Care
& eLTC
Avera
®
eICU CARE
• Provides around-the clock,
remote intensive care
monitoring of critically ill
patients
• Supports bedside clinicians with a centralized,
intensivist-led care team that uses enabling technology
to continuously monitor, assess and intervene on
patients
• Recognizes and addresses negative patient trends faster
than traditional care models
eEmergency
• Provides immediate, two-way
video access to board-certified
emergency-physicians assisted
by core of experienced emergency nurses
• Supports local providers and nurses in treating trauma,
AMI, stroke, and other critical conditions
• Allows rural hospitals to:
–
–
–
–
–
Access specialty consults
Initiate diagnostic testing before local provider arrival
Streamline emergency transfer arrangement
Eliminate unnecessary transfers
Obtain additional nursing support
ePharmacy
• Provides remote medication order
review and approval prior to first
dose
• Utilizes automated dispensing and remote order entry to
provide pharmacy support when the local pharmacist is
not available
• Leads to a reduction of serious safety events related to
duplication of medication, allergies, and drug to drug
interactions
Benefits to Patients
Avera eICU® CARE
Saving Lives
Actual/Predicted Mortality
ICU Mortality
APACHE Predicted
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
2006
2007
*
2008
2009
2010
ICU Mortality is approximately half of what APACHE predicts based on acuity
Actual/Predicted Mortality
Hospital Mortality
APACHE Predicted
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
2006
2007
*
2008
2009
Hospital Mortality is 30% less than APACHE predicts based on acuity
2010
669 Lives Saved
Shortening Length of Stay
Actual/Predicted LOS
ICU length of Stay
APACHE Predicted
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
2006
2007
*
2008
2009
2010
ICU Length of Stay is 30% less than APACHE predictions
Actual/Predicted LOS
Hospital Length of Stay
APACHE Predicted
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
2006
2007
*
2008
Hospital Length of Stay is 20% less than APACHE predictions
2009
2010
Ventilator Days
Avera eICU® CARE Avoided Transfers
“I wanted to stay near home, this way I
got to see my boys most every day.”
~Bill Sneller, Sioux Center Patient
eEmergency
2.0%
1.0%
0.0%
3.5%
3.6%
3.8%
3.6%
4.0%
4.1%
5.8%
4.2%
3.9%
4.2%
5.0%
4.6%
4.7%
3.5%
2.2%
3.0%
2.5%
4.0%
3.8%
5.0%
3.6%
6.0%
5.0%
7.0%
5.1%
eEmergency Visits as a Percent of
Total Emergency Visits
eEmergency Encounters by Chief
Complaint
Behavioral
Health
7%
Abdominal
Pain
6%
Chest Pain
20%
Major Trauma
9%
Respiratory
Complaints
10%
Neuro
18%
Other
14%
Minor Trauma
16%
eEmergency Avoided Transfers
35.0%
30.6%
30.0%
27.0%
25.7%
25.0%
20.0%
21.9%
17.5%
19.5%
15.0%
10.0%
5.0%
0.0%
Q4 -2009 Q1 - 2010 Q2 -2010 Q3 - 2010 Q4 - 2010 Q1 - 2011
Reduced Door to Physician
Time
• In 22% of eEmergency cases, the Hub
physician is available prior to the local
provider
• Within this 22%, the Hub physician is
available an average of 21 minutes
sooner
eEmergency Transfer Impact
• 282 avoided transfers
• $2,639,856 in avoided air transfer costs
• Avoided over 58,170 miles for families
(assuming one round trip)
– $29,500 in mileage
– 1,000 hours, assuming one person
“When you’re close to your family, that’s
part of the healing process.”
~Shonna Borchers, RN
ePharmacy
ePharmacy Patient Benefits
• First opportunity for 100% of orders to be
reviewed by a pharmacist prior to
administration
• 24,316 patients touched
• 2,713 serious safety events avoided
• Avoided unnecessary transfers
Interventions and Serious Safety Events
100%
90%
700
80%
70%
500
60%
400
50%
40%
300
30%
200
20%
100
10%
Total Interventions
Serious Safety Events
Apr-11
Mar-11
Feb-11
Jan-11
Dec-10
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun-10
May-10
0%
Apr-10
0
Interventions % of Scans
Percent of Total Scans
600
Mar-10
Interventions & Serious Safety Events
800
15 Most Common Drugs Requiring Interventions
Drug Name
Warfarin
Levofloxacin
Digoxin
Enoxaparin
Vancomycin
Metformin
Ceftriaxone
Ketorolac
Insulin Preparations
Morphine Sulfate
Acetaminophen
Heparin
Ciprofloxacin
Piperacillin and Tazobactam Sodium
Azithromycin
Totals
2010-2011
669
270
248
238
186
135
125
113
107
82
76
71
67
60
59
2506
% Of All
Interventions
8%
3%
3%
3%
2%
2%
1%
1%
1%
1%
1%
1%
1%
1%
1%
30%
Avoided Serious Safety Events by Type
April 1, 2010 through April 30, 2011
Anticoagulation
Issues
35%
Dosing Issues
42%
Allergy Issues
12%
Drug/Drug
Interaction
5%
Inappropriate
Abbreviation
3%
Therapeutic
duplication
avoided
3%
Impact on Workforce
eCARE Supports the
Workforce
• Access to colleagues & support for all
healthcare practitioners
• Availability of collegial consultations
similar to residency training
• Retention of existing staff – burnout
prevention
• Extension of physician practices through
mid-level providers
• Recruitment
Provider Makeup
“I've had several times that I have used eER for complicated
or unusual problems, like trauma, seizures, head injuries etc.
Generally it has been very helpful and is reassuring to have
another opinion on evaluation and treatment.”
~Dr. Gerald VanEs
Impact on Hospitals
eCARE Supports Financial
Stability
• Keeps patients local
– Increase service offerings
– Additional revenues for diagnostics & ancillary
services
– New inpatient revenues
– Critical Access – cost report eligibility
– PPS – shorter length of stay
• Supports patient satisfaction and loyalty
By the numbers…
• eEmergency: Estimated $2,800 per month
in increased of admission revenue &
average of $31,000 - $80,000 per month
saved in ambulance costs
• eICU: Estimated $12.5 million saved
annually from 5,400 ICU days saved
• ePharmacy: Estimated $400,000 has
saved by member hospitals because of
first does review
Other Benefits
• eICU: Extra layer of support around the clock may allow
more critical patients to be treated locally
• eEmergency: Specialty consults allow patients to remain
in local hospital
• eEmergency: Documentation support improves coding
accuracy; backup supports hospital preparedness efforts
• ePharmacy: Hospitals meeting CMS requirements for
24-hour, first dose review by a pharmacist
• ePharmacy: Significant cost savings achieved through
avoided adverse drug events and implementation of
automated dispensing units
Benefits
• Difficulty recruiting physicians and other
health care professionals
• Coordination of transfers
• Access to specialists
• Staffing support
Maintaining Rural Health Care
Access
Patient Volumes
Rural
Health
Care
Workforce
Economics
Questions?
[email protected]
[email protected]