- Need: Rural hospitals and healthcare providers have less access to specialty care support.
- Intervention: A service was created at Avera Health that provides 24-hour virtual access to specialty care physicians, nurses and pharmacists.
- Results: Rural patients can receive specialty care without leaving their communities, and rural healthcare providers can get needed support in providing quality care to their patients.
Evidence-levelEffective (About evidence-level criteria)
Avera Health, a South Dakota non-profit healthcare system, developed a suite of services called Avera eCARE to support participating rural healthcare providers in caring for patients. Avera eCARE connects providers by video to a team of specialists in an urban hub location. Avera eCARE offers rural providers collegial support that can ease the pressure and isolation of practicing in a rural setting, while offering patients specialty care in their own communities.
Take a virtual tour of Avera eCARE's hub to learn how it provides support to rural hospitals:
To leverage expertise and extend their resources, Avera eCARE collaborates with health systems such as Dartmouth-Hitchcock Health, The University of Kansas Health Authority, Catholic Health Initiatives, Allina Health, Emerus, and Indian Health Service.
Through its Rural Healthcare Program, the Leona M. and Harry B. Helmsley Charitable Trust has funded hundreds of rural hospitals to implement specific Avera's eCARE services.
Avera eCARE services provide around-the-clock care that includes:
- eCARE Emergency: Access to board-certified emergency physicians and experienced emergency nurses, and other specialists as needed. With eCARE Emergency, 28% of facilities have a hub physician available approximately 21 minutes sooner than a local physician.
- eCARE ICU: Remote intensive care monitoring of critically ill patients by a team of intensivists and critical care nurses.
- eCARE Pharmacy: Access to hospital-trained pharmacists, ensuring medication review by a pharmacist before administration to patients. Read about the program in the American Hospital Association's 2017 case study.
- eCARE Specialty Clinic: Access to specialty care for patients at their local facilities via 2-way video technology.
- eCARE Senior Care: On-demand urgent care services for long-term-care and assisted living facilities. Read about the related SD eResidential Facilities Healthcare Services Access Project.
- eCARE Correctional Health: On-demand urgent care services for inmates in 4 penitentiaries.
- eCARE Behavioral Health: 24/7 access to an interdisciplinary team of behavioral health clinicians offering services for emergency departments, medical, and psychiatric inpatient units.
- eCARE Hospitalist: Hospital support via a mobile cart to provide specialized care to adults in the hospital for general medical and surgical care.
- eCARE School Health: Provides school staff with an experienced nurse to assist students with chronic and unscheduled health needs.
- Professional/Continuing Education: Virtual education for providers on topics such as chronic pain management, left atrial appendage occlusion, and alcohol intoxication and withdrawal.
This video features a true story of how Avera's eCARE Emergency program helped save the life of one little girl in Nebraska.
Avera eCARE hosts other videos that give testimony to the program's effectiveness on their website.
Results of Avera eCARE services are described by Avera eCARE Data Set (unpublished) from the service's inception to August 2019.
- Serves 14% of all Critical Access Hospitals in the nation.
- eCARE Emergency averages over 1,000 video encounters a month.
- eCARE ICU reduces the hospital length of stay, time patients spend on ventilators, and common hospital-acquired complications.
- eCARE Pharmacy can help avoid as many as 7,000 adverse drug event annually.
- 90% of eCARE Senior Care residents were treated in place, avoiding transfers to higher levels of care.
- Over 450 total sites served in 30 states.
The Avera eCARE program has been recognized in the Agency for Healthcare Research and Quality Innovations Exchange as a program with moderate evidence for effectiveness. Program results identified by AHRQ include:
- Reduction in mortality
- Shorter patient stays
- Fewer patient transfers
- Cost savings
For more detailed information about program effectiveness:
- Gillespie S.M., Moser A.L., Gokula M., Edmondson T., Rees J., Nelson D., Handler S.M. (2019). Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home. Journal of the American Medical Directors Association, 20(2), 115-122.
- Mohr, N. M., Young, T., Harland, K. K., Skow, B., Wittrock, A., Bell, A., & Ward, M. M. (2018). Emergency Department Telemedicine Shortens Rural Time-to-Provider and Emergency Department Transfer Times. Telemed Journal of e-Health, 24(8). Article Abstract
This program is also featured in RHIhub's Access to Care for Rural People with Disabilities Toolkit Program Clearinghouse.
Awards and Recognition
Avera earned the highest level of recognition as a Level 10 "Most Wired" healthcare organization from the College of Healthcare Information Management Executives (CHIME) for their 2019 program.
Avera eCARE earned The Joint Commission's Gold Seal of Approval for Ambulatory Health Care Accreditation by demonstrating continuous compliance with nationally recognized standards.
Some of the barriers experienced by Avera eCARE as described in a 2014 Health Affairs journal publication include:
- Challenges related to reimbursement for telehealth services
- Variations in how hospitals are paid by Medicare
- Physician and pharmacist licensure requirements in the state where the patient is located
- Physician credentialing at the facilities receiving telehealth services
- Access to adequate broadband
Avera eCARE has served as a model for local, national, and international organizations wanting to offer telehealth services.
The National Consortium of Telehealth Resource Centers, which is funded by Health Resources and Services Administration Office for the Advancement of Telehealth, can provide assistance to organizations interested in implementing a similar approach.
National/Multi-State, South Dakota
April 21, 2014
Date updated or reviewed
November 15, 2019
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.