In South Dakota, the hub of eCare resides at Avera McKennan Hospital and University Health Center. Escorting a reporter through the facility, Panzirer kept nudging the tour guides to “tell her about” this gadget or another. It is a whiz-bang sight. Trauma and ICU doctors and nurses monitor multiple screens, toggling from one to the next, zooming in on this rural patient’s heart rate or that patient’s X-ray. The specialized guidance has reduced the average stay in participating remote ICU units by 25%, according to Avera, and has allowed outstate hospitals to keep their patients on site, rather than sending them to a bigger facility. That way, the smaller hospitals keep their Medicare dollars.
The ePharmacy unit that’s part of the virtual eCare suite likewise has multiple screens, where pharmacists can monitor the needs of patients at rural hospitals. In the remote locations, carts have been stocked with medicines at various doses, almost like vending machines, Panzirer says, so nurses can easily grab whatever the specialist in Sioux Falls suggests. “Sometimes we have to be the MacGyvers of medicine,” says one pharmacist, noting that she may have to coach a nurse on how to mix compounds if the prepared medicine is not in the cart.
Avera has been using eICU for its satellite hospitals since 2004 (the hospital estimates more than 700 lives have been saved), but it wasn’t until the Helmsley money started flowing in 2009 that the hospital could set up eEmergency sites throughout the state, including in Wagner, S.D., a town of just 1,500. The system worked one blazing hot day when friends rushed Michelle Standing Cloud, barely breathing after being bitten by a prairie rattlesnake, to the hospital.
The emergency team in Sioux Falls collaborated with doctors in Wagner and made the decision to give the girl Antivenin, a serum made from horse blood that can cause lethal reactions in many patients. Indeed, Standing Cloud’s lips and airways began to swell. But the Sioux Falls team was able to help their partners in Wagner stabilize her for the medical flight to the city.
Some rural doctors, like Dr. John Malm, a family doctor in Gregory (pop. 1,300), were skeptical when they first heard of eEmergency. But Malm became a believer when pheasant season opened in the fall of 2009. A young hunter rushed into Gregory’s small hospital — the shotgun being packed into the car had gone off, blasting his 26-year-old girlfriend in the chest at point blank range.
The Sioux Falls doctors could not help save the hunter’s girlfriend, but their presence in the ER by video reassured Malm that he had in fact done everything he could.
“It’s a pretty cold, lonely place to be,” Malm told TIME. “One minute a young person is healthy and alive, and the next you have to tell the family you’ve done everything you can, but their daughter or son is dead. … I had these young, well-trained savvy doctors (helping from Sioux Falls). I felt way less isolated. I knew there had been no stone unturned.”
It was the first time he had slept through the night after losing a patient, Malm said.
Panzirer notes proudly that one of the goals of eCare is to provide enough support for doctors such as Malm, so that good caregivers might be convinced to come to rural areas. While America’s cities average 150 doctors to every 100,000 residents, the doctor-to-patient ratio dwindles to 52 physicians per 100,000 residents in rural areas, the Trust said.
For years, hospitals, the military and even prisons have used “telehealth” programs, monitoring patients from afar or videoconferencing in on a surgery to improve quality and access; the Helmsley-funded initiative is considered more sweeping, because dozens of hospitals from six different states, with different owners, are monitoring patient data in real time to provide computer alerts when things go bad.
“They are bringing innovation to scale in a way that could not happen without philanthropy dollars,” said Jim O’Sullivan, director at Rockefeller Philanthropy Advisors, which helped the Helmsley Trust find the need. “This is the kind of revolution ATMs were to banking. … This is an incredibly alluring way to bend the curve of health care inflation and get people better care at the same time.”
After a couple of years worth of data are in, O’Sullivan predicted, other regions will follow the Helmsley-backed model and link up competing or far-flung hospitals. “Patients are going to expect their doctors to work together,” he said.