it’s my pleasure to introduce you to
Farah Heckman she just turned 11 and let
me tell you this little girl is very
happy to have been able to celebrate her
most recent birthday
you see Farah lives in rural Montana and
in June a group of 4 HS and their
parents set out from Westby Montana
heading towards a member’s farm Farah
was one of only two girls so she was
asked to ride on the side-by-side atv
her mother Melissa is very protective of
her but followed close behind in a
caravan of vehicles headed towards the
farm just to feel few short minutes
later her mother saw the ATV it was
overturned in a ditch and her daughter
was pinned underneath luckily there were
several father’s there who quickly
pulled the ATV off of Farah Farah wasn’t
moving and she seemed unresponsive they
were 20 minutes from a highway and 60
minutes from the nearest hospital when
this happened they called 911 not wait
Melissa grabbed Farah and put her in a
pickup and started heading towards the
ambulance that had been dispatched on
the way to meet the ambulance
Farrah’s breathing was labored and she
gasped for air she wasn’t talking but
would respond by shaking her head yes or
no Melissa’s saying to her and once they
met the ambulance they were still
another 30 minute drive to Sheridan
Memorial Hospital and plenty wood
montana the staff at sheridan were ready
to care for farah they had initiated a
connection with a varity care emergency
and dr. bryan scow was in Sioux Falls
and was on the video monitor with them
Farrah’s life was hanging in this
balance doctors scowl was over 600 miles
away as he guided the team at her
bedside to lead the care which involved
reinf lating both of ferry’s lungs you
see many rural hospitals don’t have a
physician there 24/7 so telemedicine can
help to cover that gap until a physician
can arrive doctors Scouse stayed on that
monitor for hours
guiding care arranging transport for
fara and reassuring the team and
Sheridan that they were
all that they could once ferret was
stabilized she was fooling the st.
Vincent health care in Billings Montana
where she was hospitalized for two weeks
in addition to her collapsed lungs she
had numerous fractures including six
ribs her jaw both shoulder blades upper
right arm as well as a bone in her spine
I don’t think I could have been that
tough Farrah is doing great today and
she’s home living a normal life she was
even able to come visit us in Sioux
Falls and see of eras II care because
she wants to be a doctor someday just
like her hero and her new friend with
whom she shares a birthday even as a PR
person I can’t make this up dr. scowl
she was also our one millionth patient
for Avera art and you care is our
telemedicine arm I tell her story
because when we say the word
telemedicine people often think only
about the technology but healthcare
first and foremost is a people business
I can buy technology anywhere it’s the
people that make the difference so what
is telemedicine telemedicine is remotely
diagnosing and treating patients through
technology it’s not a new practice and
Avera has been in the business for about
25 years now and it’s now the most
robust telemedicine provider in the
world a varity care is in over 10% of
all critical access hospitals in the US
and has saved over a hundred and eighty
million dollars in healthcare costs
since we started in the 90s so how did
we get into the telemedicine business
this really comes down to innovation our
challenges in the healthcare realm are
no different than any other anyone else
we have shrinking margins more
governmental regulations than nuclear
materials and no one wants to come see
us until they’re really really sick
healthcare needs to evolve focus on well
care instead of sick care look at
bundled care models care coordination
and navigation for patients and
telemedicine can play a major role in
that in a more cost-effective way this
need for change was really what led
Avera into telemedicine we put together
a small team of innovators to see what
they could come up with and today we’re
leading the nation because of our varied
portfolio
products I want to give you a quick
example we have a product called East
senior care this population has a unique
set of challenges
first transfers to the emergency room
are difficult and expensive and it’s
usually an aging population with
complicating health factors – you’re
treating a vulnerable population and
three they have a whole lot of
prescriptions so instead of just
thinking of telemedicine as a physician
on a monitor you need to expand your
view and think what else could we do
telemedicine can’t fix the one fatal
flaw we all have none of us are going to
live forever but with our telemedicine
Senior Care program we’re able to have
that conversation with someone sooner
you see oftentimes in these communities
the caretakers have known their
residents that are coming into their
facilities their whole lives they are
their friends and their neighbors it’s a
lot harder to have that difficult
end-of-life discussion with mr. Smith
when he was your most respected and
beloved teacher in high school we found
that we can be a disruptive external
view and ask have you had that care
consult with this person about
end-of-life care we helped to facilitate
those assessments and help with
decisions through telemedicine in
addition we helped our long-term care
facilities with all of their admissions
and medication reconciliation maybe your
great aunt is on 25 different
medications because she sees 10
different specialists who aren’t working
together through telemedicine we look at
those prescriptions reduce them if we
can look for proper interactions that
are happening and this has helped to
reduce Falls and fractures for
medication issues like dizziness in
these patients and we’ve also seen
reduced readmission rates to the
hospital one more story about long-term
care and I’ll move on but I just wanted
to share that often people become very
ill in the middle of the night you may
be at a rural nursing home and in the
past we would have just transferred that
patient out even if it’s two o’clock in
the morning now instead of transferring
them we can do those urgent care visits
through telemedicine we take about 40
calls a day and less than 10% of those
patients have to be hospitalized that’s
a great peace of mind for those families
so you see telemedicine can do much more
than what you might think of the
traditional sense of f is
not a monitor at Avera we’ve always been
in the business of going to where we
were invited and it turns out we were
invited to a great many places Avira’s
in over a hundred communities across to
five state region we have a workforce
that has to cover that region and as you
can imagine it’s very difficult to
sometimes find a pharmacist in Greggory
South Dakota or a primary care physician
to be one of two physicians taking call
every other night in Tyler Minnesota so
this really goes back to what I said
earlier that it’s not about the
technology it’s about the people I could
walk it into any Best Buy store and
purchase the technology with the
exception of the dedicated Network line
that this runs on but it’s the people
that make the difference we may not
realize that but nationally physicians
suffer burnout at a rate that’s higher
than any other American worker almost
half of all physicians have at least one
sign of burnout as health care
professionals we can’t put people into
remote and rural places without
resources and expect them to thrive and
feel supported we need to acknowledge
the immense work it takes to do rural
medicine and support it telemedicine is
an incredible way that we can do that
one day in a rural hospital a man was
brought in with a terrible wound from a
hunting accident the physician had known
this man for over 20 years and they were
good friends when the patient arrived
the care team hit the e emergency button
on the wall and within 20 seconds that
rural Hospital was seamlessly connected
with an emergency trained trauma
physician in Sioux Falls the two
physicians work together to care for the
patient when that rural physician went
home he said it was the first time in 20
years that he hadn’t stayed up all night
worrying if he had done enough worrying
that he should have done something
different for his friend telemedicine
had given him that peace of mind he had
been looking for it virtually created a
team for him to work with and suddenly
he was no longer alone that’s powerful
it’s so powerful it extends the careers
of our physicians in rural areas new
medical students pick sites with
telemedicine over non telemedicine sites
for this reason it’s become a
recruitment tool beyond offering an
extension for
physicians telemedicine also offers more
access to care patients are not needing
to travel such long distances to see
their physicians for example there are
not enough psychiatrists to cover the
mental health needs in the state and
there never will be what if we had a
behavioral health to cover those care
needs this is actually something we’re
working on right now with Indian Health
Services we only have a few neonatal
intensive care specialists across the
state our NICU physicians can see a
premature baby born in Aberdeen who
can’t be transferred out because of a
snowstorm on the video monitor thanks to
technology that physician can also
listen to that baby’s heart and lungs
through a special stethoscope with
telemedicine as if that physician was
right there in the room telemedicine
also leads to better care and outcomes
we work with some of the largest systems
such as Dartmouth Hitchcock they have
partnered with Avera because of our high
level of quality and what that means for
patients actually leads to lives saved
we’ve talked quite a bit about our
emergency let’s talk about one of our
lesser-known areas such as intensive
care a ICU as we call it we offer 24/7
remote monitoring of intensive care
patients through telemedicine trained
intensivists are always watching the
vital signs and we use a special
algorithm that will tell us when a
patient could take a turn for the worst
this helps us to intervene earlier each
year our ICU service has saved an
estimated 273 lives that would have
otherwise been lost and over eleven
million dollars of avoided health care
costs or a pharmacy we’re trained
pharmacists are double-checking
prescriptions for patients all over the
United States 24/7
the average cardiac patient goes home on
approximately thirteen medications
imagine balancing all of those medicines
thirteen drugs our pharmacist Czech drug
interactions on every patient we monitor
and they’ve checked over two million
orders and have saved more than 63
million dollars in health care costs
so as you’re seeing telemedicine can
lead to lower cost to the patients for
health care and quality care it’s not
possible to hire every specialist in
every hospital in America
and by 2025 it’s actually projected
there will be a nationwide shortage of
450,000 physicians and registered nurses
yet as we know with baby boomers and the
aging population and new people having
access to insurance through the
Accountable Care Act demand is rising so
with telemedicine we can bring a virtual
hospital to you
it helps we’ve had very visionary
partners the Leona and Harry B Helmsley
Charitable Trust has been a funding
partner with very care in 2009 they
created a rural health care program to
improve access to quality of care in the
Upper Midwest
you see they believe you shouldn’t have
to give up quality care just because of
your geography grant funding from them
has helped to further access to
telemedicine efforts through a very care
by hospitals applying and receiving
grant funding to offset the costs of
telemedicine contracts you may also be
wondering how can we treat people
remotely don’t you have to be licensed
after all the practice medicine
our telemedicine actually has its own
credentialing department and our
physicians are privileged and
credentialed in every facility and
licensed in every state in our network
so that’s a common question that we get
telemedicine is indeed the future so you
may wonder what’s next the possibilities
are really limitless I firmly believe my
generation will get the bulk of our
healthcare in the future in the palm of
our hand already Avera now is an app
that I can open them for just $49 I can
see a physician in just minutes right
from my cell phone while sitting on my
couch in my sweatpants that’s perfect
for busy professionals like me
Nadeau came to see us last year that was
pretty neat they spent two days at our
very care facility training and working
together they were working to figure out
how telemedicine could help in major
disasters so the next time there’s a
major tsunami and a hospital needs a
neurologist and then can be found could
a telemedicine operator like a varus
step in to fill that gap it’s an
intriguing thought and when we’re
continuing to work on what else is
possible when I must senior citizen I
think that I’ll get up in the morning
step on my scale put my
finger in a pulse oximeter have my blood
pressure taken and maybe a quick blood
test to look at my sugars all from a
remote monitoring system in my house
then my nurse who monitors my health
will pop up on my video monitor tell me
how my health is and recommend changes
for the day we’re not that far from this
and from what I’ve shared today the
future of healthcare is here we will
always need people to care at the
bedside for our patients telemedicine
will never replace that but telemedicine
can be an extension of that care it can
carry care across the miles to people in
need just like fara it can save in
healthcare costs by reducing unnecessary
transfers and keeping people close to
their home while receiving the most
appropriate level of care and it can
help to extend our workforce and build a
virtual team which is especially
important in rural areas where extra
people can be in short supply
there is much to be hopeful for in
telemedicine thank you [Applause]