• Brittany Evans

Remote ER's and ICU's: The Future of Rural Healthcare

Healthcare and healthcare delivery is an ever-evolving system. In the past year, we watched as COVID-19 upended our way of life; limited access to doctors, ER's, hospitals, pharmacies, every aspect of healthcare was affected by our inability to physically visit our preferred clinic. COVID-19 provided an opportunity for telehealth and telemedicine capacity to expand within the healthcare system. During the pandemic, telehealth has become the standard for most physicians and specialists considering the ease of service, remote capabilities, and disease transmission control approximately ⅓ of health visits were conducted virtually.

Before COVID-19 telehealth was becoming increasingly popular amongst rural emergency rooms (ER's) and intensive care units (ICU). There is an understated need for telehealth in ER's across rural America. Hospitals across rural America have lost 15% of their physicians in the past decade. A couple of the reasons rural areas struggle with staffing are workforce shortages and lack of peer support. Dr. Jill Kruse said that being the only physician on call at her rural hospital is overwhelming. Dr. Kruse was nearly burnt out fresh out of her residency until Avera eCARE partnered with her hospital. Dr. Kruse explains the benefits of Avera eCARE as being able to provide a second opinion when needed, providing peace of mind for her during challenging situations, and reducing her feeling of isolation. Deanna Larson, Vice President of Quality Initiatives and eCARE Services, states that Medicine isn’t meant to be practiced in isolation. Some physicians want to practice in rural areas but do not anticipate having to perform the roles of multiple specialties in medicine other than their own. The physicians need peer support, time with their families, and self-care. Avera eCare has quickly become one of the busiest emergency rooms in America, serving over 179 hospitals in 30 states. They respond to more than 15,000 emergencies each year by using remote-controlled cameras and computer screens.

Patients have also been shown to benefit from telehealth ER and ICU services. In 2010 New England Healthcare Institute partnered with Massachusetts Technology Collaborative to publish a report on behalf of eCARE services for hospitals. The report focused on the patient impacts that eCARE had; stating that the benefits of eCARE are reduced patient mortality, reduced length of stay for patients, reduced patient transfers, and lower costs for patients. Heart attack patients, for example, cannot afford to delay seeking care. Having to drive a further distance to seek appropriate care can prove fatal for urgent cases like these. One such patient, Leonard Hajek suffered a heart attack in 2011 his wife drove him to the nearest hospital; St. Michael’s Hospital Avera. A location that uses e-Emergency Care from Avera e-CARE services. Mr. Hajek states that the experience was "amazing" as if the doctor was standing right next to him. Hajek's outcome would have been drastically different without telehealth since distance and the severity of his condition meant he may not have made it to Sioux Falls.

There are a few companies breaking ground by investing in the transition to eICU's. There is a need for eICUs due to a shortage of intensivists who specialize in the care of critically ill patients, most often in the intensive care unit (ICU). The shortage of intensivists increases patient mortality and the rate of complications. SOC Telemed and Sutter Health are well-known eICU providers. Sutter Health is one of two eICUs in America and the only eICU available on the West Coast. Sutter Health and SOC Telehealth can monitor patients in ICUs 24/7, providing ease in the demand for more intensivists. eICU coverage can also help hospitals that have critical care physicians on staff, allowing them to offload some of their work and gain visibility into what is happening across the hospital and leverage their skillset more broadly. Avera eCARE is the main source of e-Emergency Care in rural America. Their services have been documented by the Washington Post, Rural Health Information Hub, Capital Journal, and other health and news publications. As we advance in technology it only seems appropriate that the role of technology would increase in healthcare settings. The expansion and improvement of telehealth and telemedicine services mean the future of healthcare is closer than we realize.


Speaking Plainly:

  • Advancements in healthcare and technology are combining to offer telehealth to ICU and ER patients in rural areas.

  • Telehealth has been shown to reduce time in ICU, patient mortality, and patient cost.

  • There are only a few companies involved in eICU and e-Emergency Care at this time.

  • The telehealth platform can help to fill gaps in staffing in rural hospitals while providing support to other staff members.