The value of telemedicine became utterly apparent during one shift at Hawarden Regional Healthcare.

Four young men, all facing critical injuries from a car crash, entered the Hawarden, Iowa-based emergency department (ED) in the space of 45 minutes. Advanced practice providers (APPs) staffing the ED quickly realized this big trauma scenario could potentially overwhelm them.

But all four survived. Changes in Iowa law allowed hospitals like Hawarden Regional to maintain trauma designations while qualified telemedicine providers, such as Avera eCARE, provide the backup services APPs may need. That telemedicine emergency service was part of the reason the outcomes in this trauma case were positive.

“Without Avera eCARE Emergency, valuable time would have been lost handling the logistics of transferring these critical patients to a higher level of care. Those duties would pull staff away from the patient’s bedside,” said Chris Mueller, Director of Patient Care, Hawarden Regional Healthcare. “Within a 90-minute window of their arrival, these young men were stabilized and transferred to tertiary care centers via three different helicopters. Our provider went from bed to bed, with the physicians from Avera backing up every decision, expediting logistics and helping to guide the transfer of these critical patients efficiently.”

Changes in the Law

Lawmakers are recognizing the value of telemedicine in other states, too, including Texas. The Texas Legislature passed HB 871 and it became law in May 2019. It lets rural hospitals with Level IV trauma designations in counties of less than 30,000 people use suitable telemedicine providers, such as Avera eCARE, to support APPs in emergency departments.

Changes in the law like these make big differences for hospital administrators, physicians and APPs as well as nurses and other caregivers. But most importantly: these services can save lives and benefit patients.

“We’re a critical access hospital so we cannot spend resources on things that do not work,” Mueller said. “For the years we have had their service products, Avera eCARE just works. Period.”

Rural Texas health care teams are already putting this telemedicine service to use – and patients are noticing.

“Avera eCARE has enhanced our emergency services by providing our nurse practitioners and physician assistants with input and guidance, as well as the easy access they have to this 24/7 resource,” said Gayla Quillin, MBA, CEO/Administrator of Parmer Medical Center in Friona, Texas. “The service also supports our nursing staff, especially in busy times, and this extra layer of expertise has helped our teams in many cases, including trauma, pediatrics, burns and cardiac emergencies. Our community sees this service as cutting edge – they cannot believe we have this cool tool in our small town.”

Rural Necessities – Hours from Big Cities

In northeastern Iowa, the MercyOne Elkader Medical Center is more than a 90-minute drive to larger facilities. When Alyssa Cram, ARNP, started her career as a nurse practitioner at the facility’s emergency department, administrators added Avera eCARE Emergency. She saw the new tool as a good addition.

“It’s hard to describe all the ways the service helps me – helps us all really,” said Cram. “When a provider is on their shift, they may have cases to cover on the patient floor as well as in the emergency room. The service almost allows us to be in two places at once.”

Board-certified emergency medicine physicians connect with providers like Cram via real-time video and audio connections, so they can recommend labs and exams, contribute consultations and also collaborate with facilities nearby if transfers are needed. Providers can focus on the patient in front of them.

Improving Outcomes without High Costs

Small facilities cannot afford every service, piece of equipment or innovation that comes along. But they can see the value in this system.

“That’s the biggest advantage for us, and eCARE has proven its worth again and again,” said Brooke Kensinger, MHA, MercyOne Elkader Medical Center’s CEO. “We have expertise available 24/7 no matter what questions we might have or what kind of cases we may face. The Avera eCARE Emergency collaborators are always beneficial and always ready to help us.”

Having a consultation with a specialist immediately available – no matter what – is a critical service that is hard to value. But Kensinger said the Avera service has paid for itself many times over.

“I cannot imagine any rural facility that would not benefit on almost every level – if great outcomes are a metric for you, this service can certainly make that goal possible,” she said. “It’s like having another staff member who is always on duty and never needs time off.”

The system builds confidence – for both providers and the people they treat.

“I’ve had patients tell me they like having that expert ‘in the room’ so we know it increases comfort levels, and it also grows confidence for everyone in the department,” said Jayson Pullman, CEO of Hawarden Regional Healthcare. “In the five years we’ve had Avera eCARE, it has been of highest quality and it has led us to add other services offered. Each one works great and has made our facility better for a price point that is really affordable.”

To learn more about Avera eCARE Emergency Services, visit or call (888) 437-9405.