May 2013
Avera is a regional health care family with more than 300 facilities in 100+ communities in the five state region of South Dakota, North Dakota, Iowa Minnesota, and Nebraska.
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Challenges in Rural Healthcare Workforce shortages Geographic isolation Diminishing community economics Low healthcare margins Difficulty recruiting physicians Increasing reliance on specialists and expensive technologies Demand for quality
Access Patient Volumes Workforce Economics Access to Care is Critical 5
Rural Physician 2013 Job Description 13,000 Diagnoses 6,000 Medications 4,000 Procedures On Call : 25% 50% of the time Know it all, No Mistakes Gawande, A. (2011). Cowboys and Pitcrews. Harvard Medical School Commencement Address. May 26,2011.
Avera ecare Improves Patient Care Enhance access to specialists and other providers Increase focus on key quality metrics Supports the Rural Workforce Access to professional colleagues, similar to urban settings Prevent burnout, provide more attractive position Extend physician practices through midlevel providers Supports Financial Stability Increase local service offerings Maintain more patients locally Support community economy
Avera ecare Services Avera ecare econsult Avera eicu CARE epharmacy eemergency elong Term Care eaccess / Correctional Facilities 105 Sites 33 Sites 53 Sites 80 Sites 5 Sites 4 Sites
History of Avera Telemedicine
econsult Allows rural patients to access scheduled specialty consults at their local facility through twoway video Video consults are supported by special stethoscopes, otoscopes, and examination cameras Benefits patients by providing Local access to specialty consults Saved time away from school or work Saved expenses of round trip travel
econsult 105 Sites Live 74 Originating (Patient) Sites 31 Specialty Sites 5,900 visits per year Total patient travel dollars saved (fiscal year to date): $419,000 Total patient hours saved in last fiscal year: 28,300 Other Services 4% Nutrition 3% econsult Utilization by Specialty FY2011 2012 Behavioral Health 15% Infectious Disease 37% Oncology 11% Cardiology 5% Total patient mileage saved in last fiscal year: 1,800,000 Pediatrics 5% Pulmonary 9% Hepatology 8% Nephrology 3%
Avera eicu CARE Provides around the clock, remote intensive care monitoring of critically ill patients. Supports bedside clinicians with a centralized, intensivist led care team that uses technology to continuously monitor, assess, and intervene on patients. Recognizes and addresses negative trends in vital signs faster than traditional care models. Supports consistent application of evidence based medicine. Provides immediate access to physicians and nurses.
Avera eicu CARE 33 Sites Live 132 Wired Beds 886 Lives Saved Second pair of eyes for 47,300 patients 29,500 ICU Days Saved, an estimated cost savings of more than $47.4M 100% Compliance with Stress Ulcer Prophylaxis
Avera eicu CARE 4 3 2 1 0 Avera eicu Average Ventilator Days Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12 100% compliance with DVT Prophylaxis 100% compliance with SUP Prophylaxis 29,500 ICU Days Saved, an estimated cost savings of more than $47.4M Avera eicu Comparison
epharmacy Provides remote medication order review and approval prior to first dose Utilizes automated dispensing equipment and remote order entry to provide pharmacy support when the local pharmacist is not available Leads to a reduction of serious safety events related to duplication of medication, allergies, and drug to drug interactions
epharmacy 46 Sites Live Average Order Turnaround Time Under 20 Minutes 1,000,000 Orders Reviewed 13,500 Serious Safety Events Avoided $37.4M in Cost Avoidance from Avoided Adverse Drug Events
epharmacy epharmacy Avoidance of Serious Safety Events Allergy Issues 6% Drug/Drug Interaction 22% Inappropriate Abbreviation 2% Therapeutic duplication avoided 2% Dosing Issues 35% 13,610 Serious Safety Events Avoided $37.4M in Cost Avoidance from Avoided Adverse Drug Events Anticoagulation Issues 33%
eemergency Provides immediate, two way video access to dedicated, board certified emergency physicians assisted by a core of experienced emergency nurses. Supports local providers and nurses in treating trauma, AMI, stroke, and other critical conditions. Allows rural hospitals to Access specialty consults Initiate diagnostic testing before local provider arrival Streamline emergency transfer arrangement Eliminate unnecessary transfer Obtain additional nursing support
eemergency in Action
eemergency 76 Sites Live Over 352,000 Square Miles Covered More than 5,650 Patients Treated Over 10,500 Transfers Arranged Over 975 Transfers Avoided Estimated $7.8M in Transfer Savings Behavioral Health 6% Chief Complaint Ortho 3% Abd Pain 6% Respiratory Distress 8% Major Trauma 10% Other 15% Minor Trauma 13% Cardiac 25% Neuro 14% 800 600 400 200 0 eemergency Encounters by Quarter Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 2009 2010 2011 2012 2013
eemergency In 25% of all eemergency cases, the hub physician was available prior to the local physician. In these cases, the hub physician was available an average of 19 minutes sooner than the local physician. Use of eemergency to assist in the management of cardiac chest pain and AMI has resulted in: A statistically significant improvement in Median Time to ECG from 12 to 8 minutes 100% compliance with aspirin administration. Patients were more than twice as likely to receive aspirin. An 18 minute improvement in door to t PA for eligible patients An 36 minute improvement in mean doorin, door out time (time to transfer) 3:36 2:24 1:12 0:00 0:11 0:10 0:08 0:07 0:05 0:04 0:02 0:01 0:00 Median Time To Transfer Comparison 2007 2008 2009 2010 2011 2012 System eemergency Median Time to ECG
eaccess Correctional Facilities 4 Sites Live 324 Patients Served 36% of Calls Result in Avoided Transfer $172,000 in Transfer Savings Shortness of Breath 2% Correctional Chief Complaints Other 18% Laceration 3% Cellulitis 4% Musculoskeletal Pain 7% Minor Skin Complaint 7% Neurological Issue 8% Chest Pain 22% Minor Trauma 15% Abdominal Pain 14% Long Term Care 5 Sites Live 82 Residents Treated via Video 30 Residents Treated via Phone 38% of Video Calls Result in Avoided Transfer
Avera ehelm 149,100 patients touched 162 hospitals and clinics served 650 providers impacted system wide 352,000 square miles covered (6 states) $55.6M in health care costs saved
Deanna Larson, SR VP Of Quality & ecare Deanna.Larson@avera.org Dr. Don Kosiak, MD FACEP ecare Medical Director Don.Kosiak@avera.org