Avera eCARE/eHELM Site Visit

Health system executives in IT, operations and clinical care from six SI Member organizations across the country gathered in Sioux Falls, S.D. September 13-14, 2017, to visit Avera Health’s eCARE telehealth operations and share lessons learned in implementing telehealth for population health. Onsite discussions enabled a “deep dive” into how Avera’s nationally recognized telehealth program expanded from telemedicine consults in 1993 to encompass the most robust telemedicine capabilities in the nation, including: ICU, Pharmacy, Emergency, Senior Care (Long Term Care), Correctional Facilities, School Health and AveraNow “direct to consumer,” Behavioral Health and Hospitalists. Avera isn’t done, planning to expand services in the near and long term.

View Avera eCARE Basics PDF

The Avera Site Visit included a tour of the Avera eCARE facility where participants could view command-center operations for Avera eCARE’s ICU, Emergency and Specialty Clinic consults and discuss lessons learned from Avera’s expansion of its scope of services and geographic footprint. Attendees heard about IT-infrastructure requirements and planning tips and still had plenty of time for Q&A and to share their own experiences with telehealth tools. The result was a better understanding of alternative business-use cases and the measured impact from such advanced telehealth applications.

John Porter, President and CEO of Avera Health, welcomed the group and emphasized that Avera’s eCARE initiative was driven by the need to increase quality of care in remote locations, particularly where specialty physician services were difficult to recruit or where sites were too remote for rapid access to the specialty care required. “Avera eCARE grew out of our rural geography,” he said, “and a need to provide support to rural areas with limited access to workforce – and it has become integral to the way we work across Avera. This is a clear-cut example of technology advancing the care we can provide to our communities.”

Deanna Larson, CEO of Avera eCARE, and Jay Weems, VP, Operations of Avera eCARE, shared management strategies and the results to date of each telehealth operation. For example, the eCARE Specialty Clinic has provided 60,000 total visits that saved 6.34 million miles in patient or physician travel, 52,000 patient hours and $2.56 million in costs. In covering 72,000 patients, eCARE ICU resulted in 1,743 lives saved, reduced length of stay by 3.38 hospital days and reduced average time on a ventilator by 13 fewer hours. Similar dramatic results occurred with other telehealth applications.

Many participants said they were originally drawn to the Avera Site Visit to learn more about eCARE ICU but realized other applications – Emergency and Senior Care, for example – would offer better starting points for their telehealth service. As Jen McKay, MD, Medical Information Officer, Avera Health – who launched Avera’s Hospitalist program – noted, “We started with the eICU application, and that was a great way to get started with the required infrastructure to support telehealth. However, once we started eCARE Emergency that suddenly became the game changer for us. The response by the local provider was immediate: the ability to have a colleague instantly available at the push of a button was astonishing!” Other key takeaways:

• Telehealth is all about augmentation, not replacement. The provider at the patient’s side remains the decision-maker.
• Telehealth is a partnership. Avera does not own all sites, which places a big emphasis on customer service.
• Telehealth is focused on addressing clinical issues, so the starting point is always a clinical champion who drives the solution.

“You need to start with the end in mind,” asserted Dr. McKay. “This is all about solving a clinical problem and leveraging technology to help create a new solution. This focus on innovation and the use of technology-enabled clinical decision-making is the future skill set for the next generation of physicians.”

Participants learned that in telehealth, like so many health-system initiatives, quick wins and success stories are critical to sustaining change. Participants agreed the Avera Site Visit was a great opportunity to exchange ideas and insights across multiple markets and settings to better understand the best starting place for a broad telehealth strategy. It also helped them see up close the promise of telehealth in terms of immediate, documented clinical and productivity results ranging from reduction in length of stay, unnecessary admissions and ventilator hours to lower mortality rates and higher patient satisfaction.

Twenty-five participants from seven SI member organizations – Avera Health, Eastern Maine Healthcare Systems, Houston Methodist, Intermountain HealthCare, OSF, Spectrum Health, and UK Healthcare – were in attendance.

SITE VISIT DESIGN & OBJECTIVES

• Avera’s eHELM, the virtual hospital hub, offered a behind-the-scenes look at a robust regional/national telemedicine program, and a collegial opportunity among SI Member CEO, CIO, and CMIO executives to discuss various business use cases and operational considerations for telehealth technologies in their respective markets.
• Tour was on Wednesday, September 13. This 1.5-hour small group tours was followed by a large group presentation of eCARE, which includes the capability for connecting diverse healthcare sites across the country.
• Discussion of eCARE/eHELM continued over dinner at Ode to Food and Drinks, 300 Cherapa, on Wednesday, September 13.
• Breakfast and Wrap-up session the morning of Thursday, September 14, CRAVE restaurant, Hilton Garden Inn.