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Jan 07, 2019

Lessons from the Frontlines of Telehealth

Estimated reading time: 8-10 minutes

Q&A with Avera eCARE’s Deanna Larson and Carla Kriwet

Every patient deserves the best care, regardless of their condition or location. Many patients in rural areas still lack this access, putting their safety at risk. Telehealth technology has grown into one of the most valuable resources for rural hospitals. These are innovations that increase patients’ access to high quality care by providing local care teams with expert guidance and 24/7 monitoring of critically-ill patients. 


One rural health system that’s demonstrating telehealth’s transformational impact on patient care is Avera Health, based in Sioux Falls, South Dakota. Deanna Larson, the CEO of Avera eCARE, spearheads Avera’s telehealth efforts, helping to provide underserved and rural communities with unprecedented access to healthcare. Earlier this year, Deanna was named Woman of the Year by the American Telemedicine Association (ATA) for her demonstrated leadership and continued service to the telehealth industry. Deanna is a leader on the frontlines of telehealth and I was fortunate enough to recently have the chance to discuss with her the power of this technology in rural communities.


Carla Kriwet: What unique patient safety challenges exist in rural areas of the country? 


Deanna Larson: In small rural facilities it’s often not feasible to staff specialists on site. Therefore, clinicians in these facilities face two options when specialty care is needed: send their patients to a higher level of care (sometimes hundreds of miles away), or forego specialty care all together – both of which put patients in danger. Additionally, since rural clinicians are often not provided the opportunity to care for the extremely ill or experience more infrequent cases and diagnoses, they can lack clinical knowledge compared to their counterparts. Even preparing an acutely ill patient for transportation to another facility requires a high level of skill and knowledge to get the patient stabilized enough for a long flight.  


CK: Rural areas like South Dakota are currently facing intensivist shortages and care transportation challenges – when someone becomes ill in isolated communities like these, what options do local care teams have to overcome these challenges?


DL: The first response to the geographic challenge is to look internally at the current care team and evaluate the level of care that can be appropriately provided. Specialty training can be obtained, equipment purchased and protocols established, in the hopes to help the local team care for a high acuity patient. At that point, if the team determines they are facing a significant care deficit for their community that cannot be overcome locally, they begin looking into telemedicine to determine if the external resource can fit their need.


CK: How does the eCARE (eICU to Philips) program specifically help combat these challenges and improve care access and safety?


DL: We strive to support all aspects of care to the ICU patient and the local staff caring for them.  Through the eICU, rural facilities bring specialty care inside their facility and can offer a higher level of care in the ICU. Intensivists are trained to care for the sickest patients, enabling them to manage and guide the care remotely, and eICU providers can review x-rays, see the full electronic medical record and use high-definition cameras to assess patients from thousands of miles away. This high-quality care is simply a button push away for the nurse caring for that patient. While many hospitals have a young nursing staff, our staff has an average of 22 years of nursing experience, allowing us to serve as a helpful resource to newer nurses.


Continuity of care is a well-known safety and quality component to patient care. Being a virtual hospital, eCARE has the unique ability to play a role in the care of patients in nearly all aspects of their hospitalization, from ER, to the medical floor and the ICU. This even occurs when a patient needs a higher level of care. We assist at the critical access hospital in the ER, manage the flight and are ready and waiting for the patient in the eICU.


CK: What were some of the specific changes introduced through the program that improved care quality at Avera?


DL: The program has enabled us to perform best practice rounds and sepsis screenings that have a direct impact on patient care. Since part of our service is catching problems before they occur and filling in gaps in care, the software helps us survey our patients and intervene early if a patient is predicted to deteriorate. Responding quickly to sepsis is essential to achieve a successful outcome and our continuous surveillance has a positive impact on those patients.

Since part of our service is catching problems before they occur and filling in gaps in care, the software helps us survey our patients and intervene early if a patient is predicted to deteriorate. Responding quickly to sepsis is essential to achieve a successful outcome and our continuous surveillance has a positive impact on those patients. 

Deanna Larson

CEO of Avera eCARE

Beyond the work we do over the camera, support offered through continuous education has benefitted patient care as well. Our various sites send clinicians to attend our Fundamentals of Critical Care Support course, which is held twice a year and is sponsored by the Society for Critical Care Medicine. Our online education portal also provides the bedside staff with a wealth of continuing education, accessible to them even when they’re at home. The offerings are updated monthly and we love getting specific requests as we have a deep pool of experts to tap here in Sioux Falls and from our remote hubs.


Looking ahead to 2019, we want to make a greater impact on sepsis and our ventilated patient populations. Earlier recognition of sepsis and increased compliance with ventilator management is our focus. Improvements in these categories will lead to improved care and overall improvement in the quality of care.


CK: Do you have an example of how telehealth has positively impacted a rural patient?


DL: The family of one patient didn’t think that their loved one would receive the level of care needed at a rural hospital based on their diagnosis and felt they needed to be transferred to a larger facility. Our local staff knew they were well equipped with Avera eCARE ICU and could care for the patient there, so they brought the family up to the ICU, gave them a tour of their unit, and also pushed the eICU button to introduce them to the eICU intensivist. The intensivist introduced himself and explained his role and the partnership between staff in the COR and staff at the bedside, comforting the patient’s family enough to continue care locally rather than transfer. This patient received the care they needed locally and was eventually well enough to transfer out of the ICU and into a rehab facility. This was a win for both parties, as the facility was able to avoid a potential transfer and the patient and family were able to receive excellent care, beginning in the ICU, close to home.  


CK: What is Avera’s secret sauce for collaborating with hospitalists across the entire Midwest? How are they able to support such an expansive region?


DL: Hospitalists fulfill an essential role within the ICU and with extremely ill patient populations and their input and acceptance of a new telemedicine service in their facility is essential to success. Before we go live with the technology (and then on a regular basis once it’s implemented), we spend a lot of time with the hospitalists to ensure they are comfortable with the service, how it’s meeting their needs and how to best utilize the program. Getting hospitalists and intensivists on the same page is essential to the success of the program and ultimately to patient care.  


For more information on telehealth’s impact on progress towards value-based care, make sure to read the findings in Philips’ latest Future Health Index report that focuses specifically on telehealth around the world.

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Carla Kriwet

Dr. Carla Kriwet

Chief Business Leader Connected Care

Dr. Carla Kriwet is Executive Vice President and Chief Business Leader Connected Care, and a member of the Royal Philips Executive Committee. 

Click here to read more on Dr. Carla Kriwet

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Deanna Larson

Deanna Larson

CEO of Avera eCARE
A nurse and quality leader, Deanna Larson is the CEO of Avera eCare based in Brandon, South Dakota, USA. One of the world’s most extensive telemedicine networks of its kind, Avera eCARE is serving sixteen states, reaching the entire healthcare continuum and serving approximately 50,000 patients/year.

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