FVH uses interactive technology to enhance care

(Sentinel photo by Amy Erickson) Mary Jo Clark, ER/trauma coordinator at Floyd Valley Hospital demonstrates the hospital's new eConsult system with the help of Lavonne Galles, a cardiac rehab nurse. Clark shows how an Exam Cam can give doctors in their Sioux Falls, S.D., office a close-up look at a patient in Le Mars.

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About a month ago the hospital rolled out eConsult and in November will bring eICU online, both of which utilize two-way interactive video equipment to connect doctors and patients.

"It all uses a technology-based system where the patient remains here and through video camera and audio they can either be observed in a bed by specialists or in the case of eConsult they sit on a chair and face the doctor who's on a screen," explained Loretta Myers, director of patient care at Floyd Valley Hospital (FVH).

(Sentinel photo by Amy Erickson) Mary Jo Clark, ER/trauma coordinator at Floyd Valley Hospital, talks about the highly sensitive stethoscope and an Exam Cam used during eConsults between patients and Avera specialists in Sioux Falls.

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eConsult

Joi Perry, of rural Le Mars, is one of those who has experienced the benefit of not having to travel to Sioux Falls to see a specialist following an Oct. 18 foot surgery.

Instead, Perry met Dr. Jawad Nazir for the first time during a two-way, interactive eConsult inside FVH's outpatient department.

"The nurse had a special camera that she brought right up close for him to see the site, the stitches and everything," Perry said.

That camera is called an Exam Cam and can focus in on any area of the body to give physicians a close-up look at that problem area, explained Mary Jo Clark, FVH ER/trauma coordinator.

Perry said being able to see the specialist doctor without leaving Le Mars is a great convenience because she's disabled and unable to drive.

Perry also noted she was just as comfortable talking to the doctor via a large TV screen as if she had been physically sitting in his office.

"I thought it was an excellent service," she said. "I would recommend it to anyone."

She will be utilizing eConsult again herself in two weeks for a follow-up appointment with the specialist, Perry said.

Along with the availability of an Exam Cam, doctors seeing patients through the eConsult service can also listen to heart beats and lung sounds, Clark explained.

She moves a very sensitive stethoscope over the patient's lungs or heart at the direction of the doctor, who listens through headphones, Clark said.

Since FVH started offering eConsult services, she said the system has been used about every other week, and patients are offering positive feedback.

"They love it," Clark said. "They don't have to drive. It feels like you're sitting in the doctor's office having a face-to-face conversation with him."

Anyone who has been referred to one of the Avera physicians participating in eCare services can connect with the doctor through FVH's eConsult service, Myers said.

"The doctors are all credentialed, all licensed in Iowa," she explained. "We keep track of the visits just like we would if there was a direct clinic."

eICU

In November FVH will roll out a new eCare service called eICU, which involves patients who need more monitoring by trained critical care staff located in Sioux Falls.

"Patients will be in a bed here and there will be a camera on them," Myers explained. "Doctors and nurses will be able to see what is their heart rate doing, what is their monitor reading. They can see all that."

She emphasized that this "extra set of eyes" won't be watching patients laying in their beds all the time, but rather monitoring vital signs such as heart and pulse rates.

"If they want to look at us, they can turn the camera on and we can visually connect with them and talk to them," Myers said. "It won't be like somebody physically watching your every move."

There is a potential that fewer patients will have to be transferred to other hospitals for these types of monitoring situations with eICU, she explained.

"I have seen documented evidence that the mortality rate is reduced using this," Myers said.

However, complex critically ill patients will still be transferred as needed, she said.

Myers said other area Avera hospitals including Sioux Center Community Hospital and Health Center and Avera Holy Family Hospital, in Estherville, already benefit from eICU.

"They use it even more in the winter," Myers said. "Sometimes it's not possible to get patients to Sioux Falls because of the weather."

She said having those critical care doctors and nurses watching over patients also gives them a "greater peace of mind knowing they are getting the best care."

ePharmacy

Another eCare service, ePharmacy, which linked FVH's pharmacy to Avera's in Sioux Falls, went online about a year ago.

It provides pharmacy coverage for FVH between 5 p.m. and 7 a.m. and on the weekends utilizing on-duty pharmacists at Avera, Myers said.

That enables doctor written medication orders to be filled during those hours with the required verification from a pharmacist, she said.

The process is all completed electronically with the doctor's orders scanned and sent to Sioux Falls where they are reviewed and verified by a pharmacist and entered into FVH's automated medication dispenser, Myers explained.

"It's ready to go with your name on it because they have your orders in," she said. "We don't physically have to go into the pharmacy to get it."

Because all medication must be pharmacist verified, if medication was needed that couldn't be accessed during those off hours the pharmacist would have to come in, Myers said.

"EPharmacy has allowed them to have a better quality of life," she said. "So they know things are being cared for."

Jerry Ashenfelter, FVH pharmacy manager, agreed ePharmacy has "greatly reduced" the amount of hours he gets called back to the hospital after shift.

"A lot of questions and reviews can be done remotely," he said. "It gives a consistent review of medication orders."

Through the verification process, ePharmacists check for drug interactions ensuring patients can take the medication safely, Myers said.

"It overall has improved medication administration," she said. "It improves overall patient safety."

eCare costs

Fifty-percent of the equipment costs for the eConsult, eICU and ePharmacy was paid through United States Department of Agriculture Rural Development grants, Myers said.

In addition, the monthly fee associated with the ePharmacy equipment is paid with grant dollars from the Leona M. and Harry B. Helmsley Charitable Trust that Avera was awarded as part of the Helmsley Rural Health Program, Myers said.

That means patients are not seeing an increase in their rates to help pay for the eCare services being offered at FVH, she confirmed.

Myers said when eCare services became available, FVH officials decided it would be a benefit for the local community.

"They've been proven to save lives. That's why we're here," Myers said. "I hope people don't have to utilize it, but if they do, we have it here available to them."