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Avera eCARE



Avera eCARE ICU links intensive care units to an around-the-clock care team led by intensivists (physician specialists in critical care). Cameras in patient rooms allow the eCARE ICU team to closely examine critically ill patients. Decision-support software continuously analyzes patient specific data, alerting the team to changes in a patient’s condition. eCARE ICU physicians work hand in hand with local providers to implement cutting-edge patient care practices and decrease the risk of serious complications. eCARE ICU monitors ICU patients in 33 hospitals in 7 states. Since 2004, more than 70,000 patients in facilities across the upper Midwest have been monitored by Avera’s team of critical care experts. Of these patients, 1,700 patients who were predicted to die left the hospital alive because of the care provided.

Nationwide, a shortage of intensivists has left the most critically ill patients without specialists trained to deliver their care. In fact, some estimate that only 13 percent of ICU patients receive care from a dedicated intensivist. eCARE ICU is one solution to this problem. Because of eCARE ICU, more than 60 percent of the ICU patients in the region receive care oversight provided by an intensivist. Through the use of advanced monitoring software and integrated electronic medical record systems, eCARE ICU has reduced mortality, length of stay and cost of care for critically ill patients across the region.

Quality initiatives improving patient care

Avera’s eCARE ICU also partners with hospitals on initiatives to improve patient care. An example of one of these projects is care of patients admitted with sepsis. Sepsis is a life-threatening illness caused by your body’s response to an infection. Sepsis is diagnosed in over one million patients each year in the US and mortality rates for the condition are estimated at 28-50%. eCARE ICU works with hospitals to ensure that patients with sepsis get the appropriate care on a timely basis. This collaborative care is resulting in decreasing mortality rates for patients with sepsis.

Sepsis Hospital Mortality Ratio


Avera eCARE Emergency

Avera eCARE Emergency supports rural clinicians in the delivery of highest-quality care, resulting in earlier interventions, improved use of evidence-based medicine, reduced unnecessary transfers, reduced complications and lives saved. Since its inception in 2009 as a pilot in eight critical access hospitals in eastern South Dakota, eCARE Emergency has grown to serve 150 hospitals across 600,000 square miles and ten states. The coordination of care through nursing documentation and transfer coordination is an added benefit to these hospitals. This translates directly into better care, better health outcomes and reduced costs for patients.

eCARE Emergency utilizes breakthrough technology to enhance the collaboration among providers and provide immediate access to expert collegial support for nurses and practitioners. With the push of a button, board-certified emergency physicians and critical care nurses are able to see, hear and provide assistance through audio-video telemedicine equipment and other medical peripherals.

More than 26,000 patients have been seen over video through eCARE Emergency, and an additional 38,000 patient transfers have been coordinated through the service. Since inception, eCARE Emergency has resulted in $29 million in cost savings, more than 4,000 potential patient transfers avoided, and a 21-minute reduction in door-to-physician response time when the local emergency providers are not immediately available.

eCARE Emergency Airway Management Initiative

Emergency endotracheal intubation is a high-risk procedure for critically ill or injured patients. Adverse events stemming from this procedure may have tragic outcomes, and include spinal cord injury, brain damage, and death. Unfortunately, most healthcare providers in rural settings do not have an opportunity to practice the skill of emergency intubation often and, thus, may not feel comfortable performing the procedure. Advances in technology and demonstrated success in the applications of telemedicine on both national and international levels represent a significant opportunity in making the most advanced resources and highly trained personnel available to the most remote of setting in a timely fashion. By utilizing a video laryngoscope linked to the eCARE Emergency system, rural providers have immediate access to an experienced emergency trained physician who can guide them through the intubation procedure.

Since 2012, eCARE Emergency has worked hard to help customer sites obtain access to video laryngoscopes. 90% of the current eCARE Emergency sites have access to the use of a video laryngoscope. Because access to the tools is not enough, Avera eCARE offers the Avera eCARE Emergency Airway Training course, powered by The Difficult Airway Course: Emergency™. This course provides physicians advanced education in difficult and failed airway management. In the last four years 180 providers have participated in this course. The eCARE Emergency staff also provide on demand education to any site who seeks it. Recent data evaluated shows a first pass intubation rate of 70% and an any pass success rate of 97%.


Avera eCARE Consult

Avera eCARE Consult connects rural patients in clinics, hospitals, long-term care centers and correctional facilities to specialists in urban communities across the region. eCARE Consult utilizes a powerful and easy to use telemedicine cart that provides high definition video to the patient and the provider, with customizable configurations for a wide variety of specialty use cases. The telemedicine cart includes:

  • Sony Handycam that offers a low cost solution for providing close-up HD video and images of lacerations and wounds;
  • FDA approved JEDMED Horus scope provides telemedicine applications including: otoscope, opthalmoscope, dermatascope and others; and
  • FDA approved RNK Stethoscope that delivers in-band, HD-audio for easy sharing of heart and lung sounds

Currently, eCARE Consult connects 150 rural sites with 31 different specialties, conducting more than 11,000 clinic visits in the last year. eCARE Consult services have saved $1 million in patient expenses, 6 million miles of travel, and more than 100,000 hours in patient travel time.

Top 10 Specialties Using eConsult

#1 in Access to Telemedicine

In a recent Telemedicine and e-Health journal study, South Dakota was ranked number #1 in the nation for providing telemedicine services to Medicare beneficiaries. eCARE Consult is instrumental in providing the nation’s best access to telemedicine and removes significant access barriers for patients.


Avera eCARE Pharmacy

Avera eCARE Pharmacy provides around the clock access to hospital-trained pharmacists for inpatient and outpatient pharmacy services. eCARE Pharmacy reviews all medication orders prior to administration and collaborates with the local hospital to prevent adverse drug events, ensuring medication safety for all patients. eCARE Pharmacy supports health care settings with reducing antibiotic resistance and works to improve the use of antimicrobial medications through an antimicrobial stewardship plan.

eCARE Pharmacy utilizes advanced two-way video technology to support health care organizations with live audiovisual and still image services. eCARE Pharmacy provides support with remote supervision of nurses with sterile medication preparation or automated dispensing cabinet refills, video consultations between eCARE Pharmacy staff and health care professionals, patient discharge medication consultations, and identification of patient medications brought from home.

Since inception, eCARE Pharmacy has reviewed more than 2.94 million orders, avoided 32,500 serious safety events and saved approximately $68.3 million with potentially avoidable adverse drug events. eCARE Pharmacy reviews an average of 60,000 orders per month and has improved medication safety for more than 980,000 patients in 73 hospitals.

eCARE Pharmacy is Efficient and Accurate

Over the last year the average turnaround time for a pharmacy order review (STAT and routine) was 17 minutes. Within that order time, orders were verified, and reviewed with 99.9% accuracy. The pharmacy team undergo clinical and electronic medical record (EMR) competency assessments annually.

Avoided Safety Events

Senior Care

Avera eCARE Senior Care

Avera eCARE Senior care uses telemedicine to support geriatric-led healthcare through innovative programs including Geriatric Services, Long Term Care and Medical Directorship. These services improve access to health care while enhancing the quality of care and quality of life for those needing specific geriatric care. eCARE Senior Care consists of a team of board-certified geriatricians, along with other geriatric health care professionals. Current programs offered by eCARE Senior Care include Geriatric Services, Long Term Care and Medical Directorship.

Avera eCARE’s fastest growing service line, eCARE Senior Care began providing services in January 2012 and recently expanded to serve 65 long-term care facilities. Over 10,360 residents have received services through eCARE Senior Care.

The overall goal of this program is to avoid unnecessary transfers, provide timely access to geriatric specialists and improve resident care transitions. eCARE Senior Care utilizes a mobile telemedicine cart that provides high definition video to the resident and the provider, with customizable configurations for a wide variety of specialty use cases. The equipment enables the facility to keep the resident in their home, avoiding transferring to a hospital which could result in severe resident health decline.

eCARE Senior Care Outcomes Show Success

Preliminary outcome data looks very promising to support evidence that the eCARE Senior Care program will assist long term care facilities in achieving clinical excellence and positive quality outcomes. Data shows long term care facilities that are highly engaged with the eCARE Senior Care program experience better outcomes with unplanned transfer rates and overtime report a decrease in 30-day readmission rates. High engagement is determined by a number of factors including, eCARE Senior Care involvement in unplanned transfers, phone utilization, and video utilization. Outcomes show highly engaged facilities experienced 13% better 30-day readmission rates and 62% better with unplanned transfer rates.

Unplanned Transfers to the ED/Hospital (per 1,000 resident days) – data below represents a positive trend in unplanned transfers since March 2015

Unplanned Transfers to the ED/Hospital

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