Telemedicine provider lends virtual assistance in 34 states

BY: JOSHUA HAIAR – MAY 3, 2023 5:21 PM
At left is the sort of button a health care provider using Avel eCare might press when in need of emergency telemedicine assistance. A doctor or nurse would then assist the provider via a monitor like the one at right. (Joshua Hair/South Dakota Searchlight)

In a small town in rural Nebraska, physician assistant Heather Kreber is one of a handful of health care providers. Patients rely on her for everything from routine checkups to emergency medical care.

On one occasion at 3 in the morning, Kreber received a call about an incoming patient with severe burns.

“It was pretty shocking when they hit the door,” she said.

She knew that the situation was critical and every second counted. And thanks to a doctor from Avel eCare, a telemedicine provider in Sioux Falls, Kreber wasn’t alone.

“She was so calm,” Kreber said. “She said you have got to get past the trauma of what he has been through and what he looks like and still treat your patient.”

The virtually present emergency-medicine doctor coached Kreber through administering anesthesia and inserting a tube into the windpipe to maintain breathing – known as intubating a patient.

“They walk you through it,” Kreber said. “They can see exactly what you’re doing, and they’ll say move it to the left, move it to the right, turn it clockwise.”

Kreber said without the help that was present via video monitor that night, “There would have been a lot more panic, especially with something that severe, that traumatic.”

 Some of the office space at Avel eCare’s headquarters, where nurses and doctors remotely administer telemedicine care around the county. (Joshua Haiar/South Dakota Searchlight)

Crucial for rural providers

Stories like that play out every day across the more than 700 sites in 34 states that Avel eCare serves. Its telemedicine care includes remote specialists, nurses, emergency care providers, behavioral health experts, and pharmacists all offering their expertise in rural and tribal health care facilities, senior living centers, ambulances and police cars. Some Avel eCare employees even serve as remote school nurses.

Some doctors and nurses work full-time at Avel, while others jump back and forth between hospitals and specialty clinics in Sioux Falls.

Starting in 1993 as Avera eCare, it was one of the first telemedicine providers in the nation to offer clinician-to-clinician services remotely. Avel eCare separated from Avera after the nuns of the Benedictine and Presentation Orders (who sponsor Avera) saw telemedicine had an opportunity to grow beyond Avera’s service territory. And thanks to ongoing rural broadband infrastructure expansion, more rural areas – inside and outside of Avera’s territory – have been able to leverage the service.

Today, the provider conducts over 1 million interactions with patients and providers annually, according to spokespeople with Avel.

The service is especially appreciated in rural areas. A 2019 poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that one of every four people living in rural areas said they couldn’t get health care they had recently needed.

By signing up for Avel eCare’s services via paid subscription, rural health care institutions are plugged into a plethora of specialists on demand. That subscription is then reviewed and, if necessary, renegotiated at the end of the year.

Dr. Tyler Price, the emergency medical director at Avel eCare, said intubating a patient in a rural town is a daunting task for practitioners who may not be fresh on the specialized training needed to perform such a critical procedure.

“The most anxiousness you’ll ever probably experience in an emergency department is an intubation,” Price said. “There’s what the textbook says, but what about the ‘oh, crap’ moments? An airway filled with blood, a mangled tongue or a pediatric patient?”

Price said niche situations like those are where telemedicine shines, bringing support to rural health care providers by allowing them to consult with specialists in real time.

 Dr. Tyler Price helps Michael Eaton – a nurse practitioner and an Avel eCare client from rural Texas – brush up on his intubation skills during a training seminar hosted by Avel eCare on April 28, 2023, in Sioux Falls. (Joshua Haiar/South Dakota Searchlight) 

Help for shortages and burnout

For rural communities, nurse practitioners are often the first point of contact for patients. They are responsible for everything from diagnosing the problem to providing treatment. However, they may not have the specialized training needed for every situation.

Jamie Hartung is a new nurse practitioner in Faulkton, South Dakota (with a population of 800). She’s sometimes the only provider on call.

“I use Avel quite often, just to run things by them and make sure I didn’t forget anything,” Hartung said.

Hartung said nurses also rely on the service to assist in recording information in the patient’s medical record – somebody at Avel actually types up the notes. Meanwhile, the nurses are able to focus on measuring the patient’s temperature, pulse, blood pressure and other vitals. This is especially useful as the nation wrestles with a nursing shortage, Hartung said.

Hartung’s husband works as a first responder. She said that by leveraging both Verizon and AT&T’s networks, Avel’s experts are able to be on screen with her husband in the ambulance, even in the most remote settings. And they can simultaneously brief Hartung on an incoming patient.

Dr. Amadin Osayomore, an emergency room doctor in Watertown, said the administrative assistance and expertise offered by Avel eCare reduces burnout for him and his team.

“When you’re tired and you want to just sign out, they don’t fight you, they just listen,” Osayomore said. “Very easy people to work with. After talking so many times, you get to know who you are talking with.”