Avera Shares How Telehealth Technologies Open New Doors for Rural Health Care (1/08/2009)

With the arrival of winter, inclement weather is an unpleasant, yet expected, hurdle for both health care workers and patients. However, in some of the more rural parts of the country, severe storms can actually bring the health care system to a standstill, preventing providers from travelling between distant sister facilities, while putting medical transports out of commission. For Avera McKennan Hospital (Sioux Falls, SD), investing in telehealth has been the key to maintaining a high level of service for their patients, no matter when or where they may need it. "By exchanging medical information and services through electronic technologies, we've enabled our physicians to talk with their peers across 25 different communities and 14 specialties," says Mary DeVany, director of Avera Telehealth at Avera McKennan Hospital and the Great Plains Telehealth Resources and Assistance Center (TRAC). "Telehealth is revolutionizing health care because it's making care more portable and convenient for everyone. Rather than deal with the hassle and expense of commuting to an urban facility many miles away, clinicians can attend education sessions and meetings remotely. Meanwhile, patients in rural areas can feel confident about receiving appropriate treatments and procedures at their own local hospital." Keys to Telehealth Preparedness As a large health care organization comprised of 233 facilities and spanning five rural states, Avera was uniquely suited to adopt telehealth for its facilities. They offer a variety of specialty services for in- and out-patients, as well as acute 24-hour care. Since 1993, the organization has been using interactive videoconferencing equipment and other technologies to conduct over 10,000 consults between the different facilities. "The baby boomer generation is likely to be the last who will expect face-to-face health care," says DeVany. "Many patients nationwide are beginning to ask for telehealth services—in general, they tend to be very comfortable with the concept." When preparing to undertake a telehealth initiative, Avera suggests starting out by taking the time to establish a comprehensive plan of action and then planning to track data to assess its impact. "By tracking key data early on, we can have more complete and comparable information. It's the best way to gauge progress, to see if you're really achieving what you want to achieve." Another important key is to start out small and build on your successes," says DeVany. "Don't try to do everything all at once. Pick one project, work out the kinks, and grow from there." Avera identifies a telehealth leader within each facility, to keep others throughout the organization engaged and informed. "The telehealth site coordinator is an essential resource for us, and someone who takes on many roles: educator, researcher, communicator, marketer, and politician," DeVany says. "This person can help to identify the needs of the facility. Then we work to bring providers and administrators together, so we can all discuss where we are going as a health care facility, and how telehealth will help us to achieve these goals. We work to stay focused on our purpose, patient care, not on the bells and whistles of the technologies." Avera works to prepare the hospital environment for the changes telehealth brings, both clinically and financially. "We made sure our network and bandwidth were up to speed and that we would be compatible with the other regional facilities using telehealth," DeVany notes. "We work with sites to ensure appropriate clinical processes are established and that reimbursement questions are resolved as much as possible before rolling out the various technologies. We utilize grants to assist with equipment purchases whenever possible." Regarding patient information, DeVany adds, "We anticipate that having a consolidated EMR will be one of the biggest advantages for us, in terms of gathering and easily viewing all the information our providers need." Avera's Results Speak for Themselves Telehealth services have had many rewards for the Avera organization. One internal study shows how telehealth can enhance patient care. "This study showed how the ability to connect to an infectious disease specialist through telehealth technologies has helped to improve medication utilization for patients with infectious diseases," says DeVany. "In this study, 26% of the patients were on unnecessary or incorrectly dosed antibiotics." Telehealth is also helping Avera's physicians to maximize their time diagnosing and treating patients. "Our physicians are viewing LIVE ultrasounds via the videoconferencing equipment. They can make a quicker diagnosis because they don't need to wait for the technician to send the tape after the procedure is complete," says DeVany. "Before telehealth, it would also take two to four days for families to receive the results of a pediatric echocardiography. Now, the results are immediate." Avera was also pleased to see benefits for the community beyond those initially expected. "Ancillary services performed as a result of telehealth services are generating additional charges for the rural facilities providing the services," says DeVany. "Additionally, the availability of telehealth services can be viewed as an economic development tool for rural communities. It keeps more dollars at home by preventing revenue from going to urban centers where patients would otherwise receive care." But has telehealth truly improved the quality of care at Avera? The proof is in the pudding: During the past four years since implementing Avera's eICU® telehealth program, 294 patients exceeded expectations by being able to leave the Intensive Care Units. Says DeVany, "These positive outcomes, as well as many other examples like them, have clearly demonstrated the difference telehealth can make for our patients."