SIOUX FALLS, S.D. (KELO) — In just one day, South Dakota went from having no Coronavirus cases to five, including one death. A team of medical professionals are screening and treating patients with symptoms in South Dakota and patients across 19 other states.

Dr. Brian Skow stands at one of the emergency bays at Avera eCARE interacting virtually with a health care worker in another emergency department.

Inside a virtual hospital in the state’s largest city, there’s an emergency department, nursing home care, intensive care, behavioral health unit, infectious disease specialists and pulmonologists, among others, standing by for COVID-19 patients, according to Dr. Brian Skow, the Chief Medical Officer at Avera eCARE.

From Junction, Texas, a town of nearly 2,600, to a small hospital in New York state and even South Dakota’s Pine Ridge Indian Reservation, Avera eCARE has the capability to jump into a patient’s room at the press of a button.

“I can see the patient the second they hit the door with the push of just one of our easy buttons. So we’re able to assess, isolate, assist the nursing staff on how to put on the protective equipment,” Skow said. “This piece is key to protect the healthcare workers.”

Avera eCARE’s emergency services are in 190 hospitals in 16 states. A spokesperson for Avera said that number is expected to be at 200 as several other sites go live in the coming weeks.

At many of these rural, critical-access hospitals across the country in underserved communities, staffing can be limited.

“Many of them are staffed by advanced practice providers, nurse practitioners who are well trained in this area. So our support level, they might have one nurse and one nurse practitioner. That’s there seeing patients 24/7, but that nurse practitioner at 3 a.m. is most likely at home; they have a 30 minute response time,” Skow said.

This map shows many of the hospitals where Avera eCARE emergency departments are located.

Once the physician or advanced practice provider arrives at the hospital, the Sioux Falls emergency department doctor is able to give a full report.

Then, they work as a team.

“We’ll help with transfer, we can call potentially the state health departments,” Skow said.

The Avera team can then check to see the state’s testing abilities and handle logistics for the short-staffed hospital.

Skow and his colleagues in the industry are on weekly calls with the Centers for Disease Control and Prevention. The federal government is stepping up telehealth as COVID-19 nears pandemic-levels.

Last week, legislation signed by President Donald Trump let Medicare expand the use of telemedicine in outbreak areas, potentially reducing infection risks for vulnerable seniors.

President Donald Trump hold up an $8.3 billion bill to fight the coronavirus outbreak in the U.S., Friday, March 6, 2020 at the White House in Washington after signing it, as Department of Health and Human Services Secretary Alex Azar, looks on. The legislation provides federal public health agencies with money for vaccines, tests and potential treatments and helps state and local governments prepare and respond to the threat. The rapid spread of the virus has rocked financial markets, interrupted travel and threatens to affect everyday life in the United States. (AP Photo/Evan Vucci)

Coverage of telemedicine was limited primarily to residents of rural areas facing long road trips for treatment from specialists. The bill allows the government to waive those restrictions to help deal with the public health emergency created by the coronavirus outbreak.

Federal leaders said they may also try to expand to Medicaid. On Tuesday, Trump and Vice President Mike Pence met with private health insurance companies to discuss the outbreak.

“They’ve also agreed to cover telemedicine so that anyone, particularly among the vulnerable senior population, would not feel it necessary to go to a hospital or go to their doctor.  They’ll know that telemedicine is covered,” Pence said.

President Donald Trump speaks to Vice President Mike Pence during a meeting on the Coronavirus with health care company leaders, in the Roosevelt Room of the White House, Tuesday, March 10, 2020, in Washington. From left, Pence, Trump, Administrator of the Centers for Medicare and Medicaid Services Seema Verma, and CEO of UnitedHealth Group Dave Wichmann. (AP Photo/Evan Vucci)

How that will work on an individual level, is still being worked out.

The medicare plan is narrowly tailored for this situation but is based on legislation from Sen. John Thune (R-SD), who introduced a bipartisan bill called the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act in the U.S. Senate last year.

“In South Dakota, telehealth is critical to ensuring patients in rural areas can access the health care services they need, especially when it comes to emergency and specialty care,” Thune said in an Oct. 2019 statement. “I appreciate the opportunity to work with my colleagues and stakeholders on this important bill to promote telehealth and expand access to services in South Dakota and across the country.”

That bill is still stuck in a Senate committee.

For now, eCARE recommends using the medical chart in your pocket. Whether it’s with Avera or Sanford Health, or any other health system, many digital charts allow people to connect via phone, chat or video with their physicians.

“This is the big piece in exactly what the CDC was talking about today, that they’re going to be leveraging telehealth as a force multiplier across the nation to isolate patients and keep them at home,” Skow said.

Force multiplication is traditionally a military term. Basically, it means tools like telehealth gives the healthcare industry the ability to accomplish greater feats, like slowing Coronavirus, than without it.

For a majority of people who contract the virus, symptoms are very mild, but for a few subsets like those 65 and older, the effects have been deadly.

Marty Shape, left, talks to his mother, Judy Shape, barely seen at right, on the phone as they look at each other through her window, Monday, March 9, 2020, at the Life Care Center in Kirkland, Wash., near Seattle. In-person visits at the facility are not allowed, as the nursing home is at the center of the outbreak of the coronavirus in Washington state. (AP Photo/Ted S. Warren)

Of the 25 deaths in the U.S. thus far, 19 were at Life Care Center in Kirkland, Washington. This situation is another reason where eCARE is helping. They are in 66 nursing homes across the country.

“We can help identify and isolate patients in a nursing home,” Skow said. “If they would require transfer, we can assist with the transfer to a critical access hospital, if they don’t have the capacity or the ability to treat the patient, we also can see that patient over the camera assist with the transfer to another emergency department where we also have cameras.”

That patient can then be sent to an Intensive Care Unit, where eCARE also has cameras at 32 hospitals.

“It’s a seamless transfer, where we have handoffs from physicians to physicians,” he said. “And this is all done virtually. When you get to the ICU, we can involve our Pulmonologists, our Infectious Disease Physicians, and they can see the patients virtually.”

The nearly 200 emergency departments also have access to those specialists through consult services.

In theory, this all may sound helpful, but there are times that require a doctor’s presence.

“There’s always still a hands-on physician there. If you’re in the ICU, that would be the intensivist. If you’re in the hospital, that would be the hospitalist and there’s always going to be a bedside physician in the emergency department, but we can add that extra level of support through telehealth,” Skow said.

There are also limits to testing. Right now that can only be done in a physical setting. However, Skow said physicians can screen patients before getting tested because there are varying levels of priorities for testing, depending on the state’s department of health.

Skow couldn’t say if his team had treated any patients with COVID-19, but did say they are answering questions about it daily in many of their service lines.

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