How Avera eCare became the gold standard for telehealth
Avera eCare has come a long way since its baby steps into telemedicine in 1993, fueled by technology, Helmsley Trust dollars and a passion for service.
Avera's eCare nerve center isn't in a hospital complex or shiny facility.
It's housed in a nondescript office park in northeastern Sioux Falls. But from here, doctors, nurses and pharmacists work to remotely support their fellow care providers at more than 300 sites across the Midwest and states as far away as New Hampshire, Nevada and Texas.
The facility is full of workspaces, with multiple, large screens showing live video feeds and patient information, including heart rhythms and diagnostic images.
Who are the largest employers in Sioux Falls? Health care tops the diverse list of top employers, which included banking, meat processing, retail and public services. Jeremy Fugleberg / Sioux Falls Business Journal
The eCare program is a broad-scale telehealth and telemedicine effort 25 years in the making, and it's come a long way since Avera opened its telehealth specialty clinic in 1993.
The eCare facility offers remote assistance with emergency rooms, intensive care units, pharmacies, senior care, correctional and school health, behavioral health and more.
"Nobody does the broad spectrum that we have here," said Deanna Larson, Avera eCare CEO. "We try to say where is there a need in our communities, we can augment what's already there, and make it 24 hours and support the person that is there to do the best they can do.
"Nobody's done that."
Larson is a 25-year Avera veteran, and worked with its telehealth efforts during her time as as senior vice president of quality. She is now the CEO of eCare.
Avera's initial telehealth goals were ambitious, but not anywhere close to the scope of its current activities. The goal, as always, was to help patients and doctors in rural areas and reduce the amount of travel needed for a patient to meet with a care provider. Without remote assistance, the cost to patients and providers was denominated in more than dollars and cents, Larson said. Patients would opt out of care because it was difficult to get.
Then there was the goal of helping rural doctors. Journal articles identified the rising problems faced by rural health care providers, stretched too thin, and the resulting gaps in care for rural patients.
While traveling across the Avera footprint, Larson said she saw the difficulties these doctors faced every day. Rural family practice physicians weren't just doing the normal work of family practice as pictured in Norman Rockwell paintings.
"Now they're out there doing trauma medicine, and stroke medicine and pediatrics and cardiology. It's just really hard to be that, so it wasn't fair," she said. "Giving them that colleague and relationship was really a driving point for me, to make sure that in the most critical of situations, like emergency or critical care, they have those colleagues they would have if they were practicing medicine here."
The need was clearly there, and while Avera was doing pioneering work in telehealth, there was so much more that needed to be done.
Then, about 10 years ago, Avera eCare met the Leona M. and Harry B. Helmsley Charitable Trust.
The eCare staff had sought federal planning grants to map out the potential of developing Avera's telehealth work. But the Helmsley Trust read Avera's grant applications with a larger goal in mind. One of the Trust's central missions is bolstering rural healthcare, particularly in the Upper Midwest.
"My goal, and the trust's goals, is it doesn't matter where you live. It doesn't matter if you live in the smallest farming community or New York City, you should have the same access to quality care," said Walter Panzirer, trustee of the Helmsley Trust.
The Helmsley Trust commissioned a study that found the Upper Midwest was particularly devoid of private philanthropic dollars, and 80 percent of donations went to Minnesota. That left quite a few Upper Midwest states, including South Dakota, with only a relatively tiny portion of private philanthropic support.
"It's the doughnut hole in America, so to speak," said Panzirer.
In Avera eCare, they saw a potential partner that could serve as a nexus of remote support for many rural communities. Avera eCare saw the Helmsley Trust's goals and realized they had a crucial financial partner with big goals and a realistic approach.
"We knew there was a chance to do something big, more, and really support people — but the funding for it ... to imagine that you could actually fund it so you could make it scaleable and make it happen was beyond our fondest or wildest dream," Larson said.
The Helmsley Trust's goal was to use its giving to propel an organization such as Avera eCare toward a sustainable business model.
"That was their brilliance — to insure the philanthropic funds they push forward have a business model built around them that is sustainable beyond their grant funding," Larson said. "It's a big deal, and I don't know that every funder puts that much diligence around that."
Funding, business model drives rapid growth
Avera eCare grew, adding eEmergency and ePharmacy partner sites, and more. And then it grew even more, first serving facilities inside Avera's footprint, but increasingly outside, based on word of mouth and need.
"What soon became very apparent was that inside of our footprint, just outside of our footprint, others were hearing about our service and they wanted it too," Larson said.
Panzirer said he's been impressed at eCare's growth, far beyond the Helmsley Trust's seven-state footprint, into states where the Trust may not fund eCare's work, but the need is there regardless.
"They originally only wanted to operate within their footprint," Panzirer said. "We stretched each other, I stretched them and my team stretched them, that this is a bigger horizon, this is really something special and something great that you can do with this platform."
The rapid, succesful growth has garnered Avera eCare attention from many corners. The facility includes a tour path so visitors can see the facility without disturbing the staff. About five to seven groups – other health systems, community and hospital boards and others – tour the facility each week.
"Other health systems are starting to figure out this is a leverage, a force multiplier to reduce costs," Larson said. "So they're all interested in how this works, how we do that."
Still, other large health systems may not have as much of a rural focus compared to Avera, or they're not as nimble as Avera has proved to be, willing to take chances with new approaches to healthcare, she said.
Avera eCare might be operating at a scale unknown to others. But there's still plenty of room to grow.
Panzirer said the acute shortage of mental health professionals everywhere, including the Upper Midwest, shows one way Avera eCare's work could expand even more. And rapid development of technology is opening even more avenues for growth.
"I think it's endless," he said.
Avera eCare has engrained an innovation cycle into its culture, as a way to capture ideas that bubble up from care providers and other staff, test them, and if they prove worthy, develop them into full-scale programs.
"The intellectual capital here is being institutionalized," Larson said.
And eCare will "continue to scale and spread," she said. It is expanding its work to assisting facilities in Texas, and other states. The growth is fueled by the mission established by the Presentation Sisters and Benedictine Sisters of Yankton, the joint founders of the Avera health system: to improve the lives in the communities Avera serves, guided by the values of compassion, hospitality and stewardship.
"I'm telling you, the mission is alive and well out here, and these people here feel like ambassadors of the Avera mission," she said. "It's really God's work. It really is."