Photo by Jody Isaackson Avera Marshall ER doctor Tim Hindbjorgen points out the microphone used during eCare calls for assistance. The Avera eCare program is celebrating 25 years of service to patients especially in small town hospitals.

MARSHALL — The world’s most extensive and diversified virtual care network, is celebrating 25 years of delivering a wide continuum of services to meet varied needs of patients, clinicians and health systems including Avera Marshall.

Avera eCARE has several distinct areas: Intensive Care Unit, Emergency, Pharmacy, Senior Care, Correctional Health, Specialty Clinic, Behavioral Health, Hospitals and School Health. Avera eCARE harnesses interactive video and computer monitoring technology to extend specialty care from its eHelm “virtual health center” in Sioux Falls to 400+ sites in 17 states.

The eCare system connects the Avera Marshall emergency room to its sister hospital, Avera McKennan, in Sioux Falls, and over 300 other locations. The doctors and nurses working at Avera Marshall ER have access to their assistance.

Having been on the receiving end of emergency eCare calls for a couple of months during his residency, Dr. Tim Hindbjorgen of Avera Marshall felt pretty comfortable taking up the other end of the line when emergency room cases require it.

“Depending on the acuity of the patient, I may call Avera eCare support,” Hindbjorgen said. “If the patient is likely to go down to (Avera McKennan), I’m more likely to get them on board early in the treatment.”

Hindbjorgen and Emergency Department Manager Karen Maher agreed that having the eCare team assist with bedside care was helpful, especially for patients who would be transported to Sioux Falls.

“It makes the transfers go that much more smoothly,” Hindbjorgen said. “I call it the ‘Easy Button.'”

When he pushes the “Easy Button,” a large television screen on the Avera Marshall ER wall lights up and certified ER nurses such as Donna Eschenbaum and Tom Berg appear and can have two-way face-to-face conversations in real time.

Eschenbaum and Berg are happy to assist in such areas as calling ambulances or flight crews for transport, calling law enforcement personnel if needed, monitoring patients, language interpretation and ordering prescription medication if the doctor had to leave the ER.

“One night I had to call six different ambulances to find enough to transport four patients,” Berg said. “Think about how much time away from bedside that would have taken for the attending personnel.”

“With eCare team assistance, we can have patients stabilized and on their way within 30-35 minutes,” Hindbjorgen said.

“If the hospital calling has Medi-tech, we can go into their records system just as if we’re standing there bedside,” Eschenbaum said. “Two things we cannot do are to administer medications and chart information into their records, but we can be quoted by those who do.”

She added that the eCare team does not take control but is there to assist the doctor and nurses who are physically on the scene with the patient.

During their busiest times, from 1 p.m. to 1 a.m., eCare team members can also provide triage services, helping prioritize patients in the order they need to receive attention, Eschenbaum said.

The control center has 13 cameras and usually runs two certified ER nurses at one time, with a third nurse on the floor beginning at 1 p.m. There are usually a supervisor, a nurse manager and a shift chiefs available as well, she said.

“Avera eCARE is transforming rural health care by delivering the right care at the right time, supporting local rural health care staff, improving quality of care, reducing health care costs and improving patient outcomes,” said Deanna Larson, Avera eCARE CEO.

Avera eCARE saves money, careers and most importantly–saves lives, she said by working with partners to address the most pressing challenges in health care.

“In one case, eCare helped save days of traveling for one North Dakota family,” Eschenbaum said. “There would have been a 12 hour ride to St. Paul for burn treatment. With eCare, the patient could just stop once a week at his local hospital and go back to work instead of traveling hundreds of miles to see a specialist.”

Throughout its history, eCARE has reached over 1.4 million patients, and the efficiencies of this system have saved an estimated $200 million in health care costs and millions of miles of travel for both physicians and patients.

eCARE saves careers by providing an extra layer of support in rural locations or long-term care centers that can help prevent burnout, public relations representative Jake Iverson said.

Lives are saved in numerous examples, for example, through immediate assistance in rural emergency rooms at the time of medical crises such as heart attack, stroke or traumatic injury. eCARE Pharmacy helps prevent dangerous medication errors, Iverson said. And since its inception in 2004, eCARE ICU has saved an estimated 1,90,890 lives.

In 1993, Avera began telemedicine with a pilot project, connecting specialists in the city of Sioux Falls to rural community partner facilities, Iverson said. In 2004, Avera expanded its telemedicine offerings to include eCARE ICU, its first 24-hour, on-demand service that allows staff at partner facilities to connect virtually for immediate assistance from board-certified providers.

Today, Avera eCARE is looked to as a model by national and world organizations, having collaborated with health systems across the country, NATO, U.S. Health and Human Services and the White House, Iverson said. Avera eCARE Emergency serves 13 percent of all critical access hospitals in the United States, bringing lifesaving specialty expertise to the most remote locations.

“Over the span of 25 years, Avera eCARE has developed an innovative network to meet our unique needs as a health system serving a largely rural population,” Larson said. “We continue to expand, forging new partnerships all the time as health systems, hospitals, long-term care centers, clinics and schools learn how an established, experienced telemedicine network can serve their specific needs. To our knowledge, no one else in the world is offering the breadth or depth of services that impact patients and clinicians like we’re doing.”

To learn more or contact Avera eCARE, go to AveraeCARE.org.