Healthcare IT Innovation in a Place Where Many Say it Can’t Happen – a Rural Setting

Perhaps there’s no better place for a case study on effective use of telemedicine and health IT interoperability than in my native South Dakota.

Avera Health, a network of hospitals, family care practices and specialty clinics located in South Dakota, Minnesota, Iowa and Nebraska, opened an e-care hub in fall 2012 in Sioux Falls as way to shrink care gaps in rural medicine throughout the state and across the Northern Plains. Well, So. Dak is made up of nothing but rural areas, so this is the perfect place for an experiment.

The intent is to use electronic services to help rural patients stay closer to home and to boost small-town economies, but according to The Sioux Falls Argus Leader, officials say it also is creating a model for other systems nationally and beyond.

According to the report, doctors, nurses and pharmacists working at Avera uses two-way video and electronic data transfer to support medical care in 100 cities and towns in six states. About 100 people work at the center, which opened in October and runs around the clock in Sioux Falls. “The hub supports 32 Avera hospitals, including Avera McKennan, which means two-thirds of the 100 locations served are outside the Avera network.”

Interestingly, health systems from Alaska to Sweden, and from Ohio, Denver, Minneapolis and the University of Pittsburgh have sent visitors to study the setup. According to the program director, Shelley Stingley: “There are tele-health networks and a lot of tele-consulting going on where a doctor can beam into a clinic somewhere, but there’s not a co-op like this. This is the only one of its kind.”

Additionally, “It’s extending the time doctors can practice out there,” Stingley said. “And it gives towns a pharmacist. They have a pharmacist, but they don’t have one 24 hours a day. Now they do. The idea is to share this across the Upper Midwest.”

Amazingly, the e-care center brings five separate health functions to one spot. One of them, called e-icu, connects the hub with intensive care units across the Upper Midwest. A partial wall separates the e-icu from a second section called e-pharmacy, where pharmacists respond to requests for prescriptions from area hospitals. Another wall creates a third section, where workers provide assistance in two more areas by linking up with rural emergency rooms and nursing homes. The final element is what officials call e-consult, where doctors off-site respond to needs in areas such as infectious disease and dermatology.

In each case, workers at the hub have no hands-on connection with patients, only a virtual relationship with the on-site health team.

Avera began using telemedicine in 1993 and added e-icu in 2004. The effort still was relatively small in 2009, when the Leona M. and Harry B. Helmsley Charitable Trust made a $13.5 million grant to Avera for e-care in rural pharmacy and emergency services. The Helmsleys added $30 million for community hospitals and in 2012 gave Avera another $2 million to set up the e-care center as the centerpiece in its rural outreach.

It’s not the only way to do it. Sanford Health, a nonprofit healthcare delivery system in Sioux Falls, covers a similar array of long-distance features including video consultation and 24-hour neonatal and emergency services, but Sanford does not use a central hub, preferring to keep doctors in clinics to respond to requests for help.

Participating hospitals outside the network pay Avera for the services. If a rural patient receiving e-care needs to transfer to a bigger hospital that might mean crossing over to another network if the patient chooses.

The arrow points both ways. For example, Sanford Medcenter One in Bismarck, N.D., is using Avera’s e-care services under a contract in place before MedCenter merged with Sanford last year. In Rapid City, Regional Health uses Avera’s electronic ICU, as does Regional’s sister hospital in Spearfish, where the setup is particularly helpful. Spearfish has no physician in intensive care, but staff members are able to keep ICU patients there by working with Sioux Falls.

According the Avera (via the Argus Leader) e-care potentially presents an opening for the Sioux Falls hub to reach any spot on the globe with Internet.

If nothing else, this is a fine example of interoperability working successfully. If something else, it’s a great example of innovation in a place where many in health IT say it can’t happen – in a rural setting.


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