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Telemedicine and eEmergency Care Goes Where the Need Exists

by Brian S. Skow, MD, MBA, CPE, FACEP Chief Medical Officer, Avera eCARE

I became a physician in emergency medicine to treat patients at all stages of life – from newborns to the elderly, to take care of them during their time of need rather than on their ability to pay for services.

My emergency department (ED) colleagues and I often discussed how care might improve if we could see patients earlier to avoid unneeded transport to tertiary facilities. That way, patients treated by local clinicians could then remain in their own community.

Introducing Telemedicine

About 10 years ago, with 2-3 pilot sites in our Avera Health network, we tested this approach with telemedicine. With support from the Helmsley Charitable Trust, the program expanded exponentially through word of mouth and growth of Avera.

Since that time, I’ve conducted more than 15,000 telemedicine visits with patients through Avera eCARE, which provides care to 200 critical care access sites in 16 states with a hub in Sioux Falls, SD. Our emergency clinicians have immediate access to patients through video consultations, a time savings that matters in life-threatening situations, as our research shows.

Ongoing collaboration and consultation between eEmergency physicians and their clinician colleagues in rural communities matters; we work as a team to improve access to specialty care, lower costs and overall, improve patient care.

Saving Time and Lives

For example, a 50-year-old man recently came into the ED with a heart attack in one of our rural community hospitals. The hub team of e-Emergency physicians and nurses saw him in real time via video. In about 20 minutes, they obtained an EKG on arrival, administered lifesaving thromoblytics, called the helicopter for transport to a heart hospital, and talked by phone with a cardiologist. By the time the bedside physician arrived, with the flight team also in the room, the local doctor conducted his exam. The patient then flew to a cardiac catheterization lab and was home in a day.

Telemedicine goes where the need exists, and in a bittersweet moment, the current pandemic demonstrated what remote patient care can accomplish. Through the Covid-19 virtual command center at the hub location, we transferred Covid hotline phone calls to our video platform and avoided many ED visits because – via the camera – we determined whether or not patients needed emergent treatment.

Looking Ahead with Telemedicine

Despite this immediate response to the virus, we sometimes don’t realize available service options until they are created through observation of our current telehealth connections. One rural ED in our system, for example, transferred sexual assault cases to a larger facility for certified exams that required a 3-hour ride, many times in the back of police vehicle. Now, over the camera, trained sexual assault nurse examiners assist local clinicians and conduct the exam locally.

As a member of the American Board of Telehealth Advisory Council, I interact with telemedicine leaders across the country who deliver quality patient care with telehealth services. The ABT Telehealth Certificate Program offers clinicians and administrators specialized knowledge with standards in place to implement quality remote patient care.

Find out more about the ABT Telehealth Certificate Program.