Agenda
• Background of Avera
• Development of Avera eCARE™
• Description of Avera eConsult Service
• Description eEmergency Service
• Questions
Avera
Avera is a health ministry
rooted in the Gospel.
Our mission is to make a positive impact
in the lives and health
of persons and communities
by providing quality services
guided by Christian values.
Avera
Meeting Rural Health Care Needs
• 1897: Benedictine Sisters respond to need for health
care in Yankton
• 1901: Presentation Sisters respond to diphtheria and
typhoid epidemics in Aberdeen
• 1993: Avera’s first telehealth services
• 2004: Avera assesses how to continue to provide access
to high quality care in the decades ahead
Current:
Challenges to Rural Care
• Workforce shortages
• Geographic isolation
• Diminishing community economics
• Low healthcare margins
• Difficulty recruiting physicians
• Increasing dependence on specialists and
expensive technologies
• Demand for quality
Community
Workforce Needs
Research Findings:
• 41% of health care workers surveyed were over 50 and
planning to retire in 15 years
• Recruitment of physicians may take 2 to 4 years, often
required a 15% increase in initial salary offering, and
significant reduction of call expectations
• New nursing graduates often feel
overwhelmed and isolated
• Rural students want to stay in their
communities
Identification of Problem(s)
Access
Patient Volumes
Rural
Health
Care
Workforce
Economics
Agenda
• Background of Avera
• Development of Avera eCARE™
• Description of Avera eConsult Service
• Description eEmergency Service
• Questions
eCARE Design Requirements
• Economical & Efficient
• High-Quality
• Robust
• Customer-Friendly
• Replicable
• Resource Leveraging
Avera’s Leverage Points
• Technology and broadband infrastructure in place
• Experience with Avera eICU® and telehealth
• Electronic Medical Record (EMR)
• Regulatory requirements within pharmacy
Solutions
• Provide a full suite of telehealth services to maintain
access and keep patients local
• Pull together existing services under one umbrella to
gain efficiencies and raise quality
• Develop new telehealth modalities to address needs and
cover the continuum of care
• Leverage existing resources to keep costs low
• Work directly with stakeholders, funders and local
government
Avera eCARE™ Services
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Mission
Avera will utilize
Avera eCARETM
strategies to develop and
maintain quality health
care services in rural
communities
eConsult
Teleradiology
eICU® CARE*
Telehome Health
ePharmacy
eEmergency
eStroke
eNursery
eUrgent Care
Clinical Education: Grand rounds, EMT training
Other services: family connections, sign-language
services, transplant assessments, public education
eICU® is a registered trademark of Visicu, Inc.
Avera eCARETM Services
• Acts as umbrella concept for telehealth and health
information technology
• Maintains or improves access to quality care
• Addresses needs of rural patients and facilities
• Covers the continuum of care working towards a virtual
hospital
• Bundles services to gain efficiencies and raise care
quality
Agenda
• Background of Avera
• Development of Avera eCARE™
• Description of Avera eConsult Service
• Description eEmergency Service
• Questions
Avera eCARETM
eCARE
eConsult
eICU
eEmergency
eStroke
ePharmacy
eUrgent
Care
eNursery
What is eConsult?
• Leveraging technology to provide medical services
when the healthcare provider(s) and patient are
separated by time and geographic distance.
• eConsult technology usually involves live interactions
between the provider and patient via two way video.
Why eConsults
• Rural state/service area
• Professional shortage
• Aging population
• Budget restraints/economics
• Support for rural communities
• Increased access to technology
How it works
• Two way video units at specialist office and in local clinic
site
• Nurses Role
• Physician Role
• Patient Role
Basic Equipment
eConsult Statistics
• 350 eConsults per month
• 56 sites
• 16 specialties - 33 providers
Avera Annual e Consults, July 2001 - June 2009
6,000
4,470
5,000
3,773
4,000
2,616
3,000
1,780
2,000
1,000
659
980
947
886
2003
2004
2005
0
2002
2006
2007
2008
2009
Types of Specialties
Pulmonary
Cardiology
Dermatology
Infectious Disease
Neonatology
Hepatic Specialty
Endocrine
Orthopedic
Pediatrics
Neurology
Top 7 specialties
3%
5%
5%
3%
37%
7%
12%
Infectious Diseases
OB Ultrasounds
Psychiatry
Pulmonology
Oncology
Dermatology
Peds Echos
Others
28%
Total 2005-2009
What are the Benefits?
Provider
Community/Facility
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Access to Specialist in local community
Saves time and travel dollars
Family can be present
Enhances coordination of care
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Supports primary care provider’s practice
Professional shortage
Access to medical education
Enhances professional relationships
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Supports local facility
Specialists can have “virtual” presence in a community
Access to medical education
Travel dollars
Access
Customer Satisfaction
• 98% rated experience good to excellent
• 100% would recommend eConsult
• Availability of telemedicine saved:
– 95% of patients expenses related to travel
– 36% of patient the need to find someone to drive
them
30% of patients would not have received
care without an eConsult option
Agenda
• Background of Avera
• Development of Avera eCARE™
• Description of Avera eConsult Service
• Description eEmergency Service
• Questions
eCARE
eConsult
eICU
eEmergency
eStroke
ePharmacy
eUrgent
Care
eNursery
What is eEmergency?
Innovative concept linking two-way
video equipment in rural emergency
rooms to emergency trained
physicians and specialists at a
central hub, 24 hours a day, seven
days a week.
How eEmergency Works
• Immediate access
• Mounted, two-way, interactive video units
• Provides oversight until the physician
arrives
• Local provider always serves as primary
• No patient billing from eEmergency
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eEmergency Statistics
• Initial Go-Live: October 15,
2009
• 17 Hospitals Live
• 6 Hospitals in Progress
• Up to 25% of patients
going through eER a
month
The Local Emergency Room Team
• Requests consults from
emergency-trained
physicians around the
clock, as needed
• Has streamlined access to specialists for better outcomes
for patients with trauma, stroke, sepsis, acute MI and
other emergency care issues
• Accesses support during difficult and multiple emergency
cases
• Avoids unnecessary transfers, keeping patients nearby
home
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The eEmergency Team
• Board-certified Emergency Department physicians
• Certified Emergency Registered Nurses
• Staffed 24 hours a day, 365 days a year
• Available for emergency and specialty consultation
• Initiates diagnostic testing, which supports rapid decisionmaking and treatment upon arrival of the local physician.
• Supports activation of emergency transport teams when
needed, saving precious seconds during the Golden Hour
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Supports rural Providers by:
• Offering “another look”
• Accessing transfer
coordination
• Easing isolation
• Creating a network of
specialists
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Provider Makeup
Provider Breakout
Midlevel
Providers
15%
All other
physicians
73%
Physicians
Practicing
2 years or
less
5%
Locums
7%
Service Utilization by Provider
All other
physicians
57%
Midlevel
Providers
24%
Physicians
Practicing 2
years or less
19%
Locums
0%
eEmergency Utilization
Encounters by Chief Complaint
4% 2%
8%
Minor Trauma
20%
Other
Neuro
6%
Chest Pain
6%
Major Trauma
18%
Behavioral Health
Respiratory Complaints
20%
16%
GI Complaints
Headache
Supports rural facilities by:
Transfer Avoidance ► Keeping patients local
Avoided Transfers % of Total Site Encounters
25%
Apr-10
6%
15%
10%
Mar-10
14%
20%
23%
30%
24%
25%
35%
32%
35%
40%
5%
0%
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Supports rural facilities by:
• Generates higher reimbursement
 Critical care, labs, overnight stay
• Decreasing locum tenens costs
 Midlevel backup
• Boosting recruitment and retention
 Support from the eER Hub
• Supporting trauma level designations  Onsite training
• Offering ongoing training
 New staff
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Connectivity & Systems
• Point to Point Connection
• Leverage USAC Funding for T1 or similar design
• Hardwired in the ED
– Equipment is always available and ready to connect
• One Touch Access
• Polycom 8000 HD with 32 inch Monitors
Economics
• Increased ER billings of $140 per eER patient through
better documentation and appropriate coding
• Avoided transfers increase inpatient volume resulting in +/$2,500 per patient
• Equipment can be placed on cost report (gifted / capital
credit)
• Increased staff retention, reduction of recruitment costs,
estimated at $50,000 per provider
• Decreased use of physician locum-tenens coverage
resulting in significant cost savings**
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Start-up Funding for Avera eCARE
Grants awarded since 2005:
• Office for the Advancement of Telehealth, Telehealth Resource
Center Grant
• 7 U.S. Department of Agriculture, Distance Learning and
Telemedicine Grants
• Office of Rural Health Policy Network Planning Grant
• Office of Rural Health Policy Outreach Grant
• 3 Grants from the South Dakota Department of Health
• Federal Communications Commission Rural Health Care Pilot
Program Awardee
• 2 Grants from the Leona M. & Harry B. Helmsley Charitable Trust
More than $21 million total grant dollars garnered
Private Funding Opportunity
The Leona M. and Harry B. Helmsley Charitable
Trust aspires to improve lives by supporting
effective nonprofits in health and medical research,
human services, education, and conservation.
• Established in 1999
• In April 2009, the trustees announced the first round of
grants since the death of Mrs. Helmsley, totaling $136
million.
• $42 million has been awarded to Rural Health Programs
Questions?