A tractor operator impaled by a gearshift on the outskirts of small rural town. A mother bitten by killer rattlesnakes in the Badlands of South Dakota. An executive falls down a flight of stairs at a remote hunting lodge and crushes his chest.
Each is far away from adequate medical care. Each cling to life. And arguably each is saved by telemedicine and the team at Avera eCARE.
“Doug [the tractor driver] walked away from an accident that should have killed him, and with telemedicine we were actually able to identify how sick he was and avoid the procedures that potentially could have killed him,” Brian Skow, M.D., Chief Medical Officer, Avera eCARE, told a rapt audience at the Telemed Leadership Forum in Washington, D.C. on April 3, where he recounted several harrowing and inspiring rescues.
“The big piece with the telemedicine here is we can identify when they’re sick sometimes, rather than just try and get them on the road and treated,” Skow said. “Now this doesn’t happen often, but these are kind of the outlier cases.”
However, Skow was also able to articulate the value of telemedicine beyond the emotional impact of anecdotal stories. Avera eCARE’s emergency partners have seen significant savings thanks in part to leveraging telemedicine services.
“From avoided [patient] transfers, we've estimated $30 million in cost savings since inception” of the program, he said, “and that's a pretty conservative estimate.” On the e-emergency side, currently partnered with 200 facilities, “we've had over 150,000 video encounters,” he said.
Avera eCARE is in 450 sites across 25 states. “We really started back in 1993 and our very first consult was a pulmonary consult that we did for a cancer patient in South Dakota,” Skow said. This was later followed by Avera’s emergency intensive care unit (EICU) care.
Currently, Avera monitors some 225 ICU beds across several states. It also has a pharmacy program at more than 120 sites. “And all of these services lines are inside our virtual hospital,” Skow explained. Avera also has a team of geriatricians who monitor approximately 4,000 nursing homes beds. They also offer services in schools, correctional facilities, and an Indian Reservation. Avera also offers an extensive behavioral health program which is a 24/7 outpatient, inpatient, and emergency room practice.
Skow shared some keys to program success. “Number one, it's ease of use. So, we have an easy button. That's all you have to do to get us up and running. Push the button and our faces are up there in about 15 seconds,” he said.
The human factor is equally important. “It’s about relationships,” Skow explained. Avera conducts daily camera checks and regular medical staff meetings at 30- and 90-day intervals. “We have a physician in our group,” Skow said, “[who’s] entire job is to travel and do medical staff meetings.”
There’s no replacement for face-time and connecting with the right people on the project, he said. “I mean we can get administrators to buy this all day long. It's getting the physicians engaged which is really the key,” he noted.
“Education is big, too,” Skow said. It’s vital to be able to demonstrate the value and quality of the technology and team. “We really are starting to show good outcomes; we've got 11 published articles just on e-emergency.”