Telehealth Network Research Articles

Views of Patients and Providers on the Use of Telemedicine for Chronic Disease Specialty Care in the Alaska Native Population.

Background: Chronic diseases disproportionately affect minority and rural populations. Specialist access improves health outcomes in many chronic diseases but access to specialist care may be limited. Video telemedicine can expand access to specialists in rural locations. Introduction: The objective of this study was to understand patient and provider perspectives on the benefits, barriers, and best uses of video telemedicine in chronic disease specialty care in the setting of a well-established store-and-forward telehealth network with recent expansion of video telemedicine. Materials and Methods: Patients and providers were recruited from specialty clinics at the Alaska Native Medical Center. Semi-structured interviews were conducted after a brief survey. Interview questions focused on perceived benefits and barriers to use of video telemedicine for chronic disease specialty care, as well as the best uses of telemedicine and factors that improve the ease of use. Results: Participants considered the major benefit of telemedicine to be a reduction in travel and related costs. Telemedicine was considered by most participants as less appropriate for new conditions or for new patients. Limitations included the need to perform a physical examination or needing tests, procedures, or medications that cannot be performed in rural clinics. Discussion: This study describes the views of patients and providers who have experience with telemedicine. It did not evaluate the cost-effectiveness or impact on health outcomes, although further studies are planned. Conclusions: Patients and providers view video telemedicine as a reasonable addition to in-person visits for the management of chronic disease, although there are limitations.

Automatic diagnosis of the 12-lead ECG using a deep neural network

The role of automatic electrocardiogram (ECG) analysis in clinical practice is limited by the accuracy of existing models. Deep Neural Networks (DNNs) are models composed of stacked transformations that learn tasks by examples. This technology has recently achieved striking success in a variety of task and there are great expectations on how it might improve clinical practice. Here we present a DNN model trained in a dataset with more than 2 million labeled exams analyzed by the Telehealth Network of Minas Gerais and collected under the scope of the CODE (Clinical Outcomes in Digital Electrocardiology) study. The DNN outperform cardiology resident medical doctors in recognizing 6 types of abnormalities in 12-lead ECG recordings, with F1 scores above 80% and specificity over 99%. These results indicate ECG analysis based on DNNs, previously studied in a single-lead setup, generalizes well to 12-lead exams, taking the technology closer to the standard clinical practice.

Telehealth: An Opportunity for State and Territorial Health Agencies to Improve Access to Needed Health Services.

Telehealth: An Opportunity for State and Territorial Health Agencies to Improve Access to Needed Health Services.

ECG Characteristics of Sleep Apnea Patients Undergoing Endoscopy with Deep Sedation

Digital electrocardiographs are now widely available and a large number of digital electrocardiograms (ECGs) have been recorded and stored. The present study describes the development and clinical applications of a large database of such digital ECGs, namely the CODE (Clinical Outcomes in Digital Electrocardiology) study.ECGs obtained by the Telehealth Network of Minas Gerais, Brazil, from 2010 to 17, were organized in a structured database. A hierarchical free-text machine learning algorithm recognized specific ECG diagnoses from cardiologist reports. The Glasgow ECG Analysis Program provided Minnesota Codes and automatic diagnostic statements. The presence of a specific ECG abnormality was considered when both automatic and medical diagnosis were concordant; cases of discordance were decided using heuristisc rules and manual review. The ECG database was linked to the national mortality information system using probabilistic linkage methods.From 2,470,424 ECGs, 1,773,689 patients were identified. After excluding the ECGs with technical problems and patients <16 years-old, 1,558,415 patients were studied. High performance measures were obtained using an end-to-end deep neural network trained to detect 6 types of ECG abnormalities, with F1 scores >80% and specificity >99% in an independent test dataset. We also evaluated the risk of mortality associated with the presence of atrial fibrillation (AF), which showed that AF was a strong predictor of cardiovascular mortality and mortality for all causes, with increased risk in women.In conclusion, a large database that comprises all ECGs performed by a large telehealth network can be useful for further developments in the field of digital electrocardiography, clinical cardiology and cardiovascular epidemiology.

E-health and governance models - a scoping review

Abstract Background Research has shown that national large-scale e-health projects are rarely defined as successful. Methods We have conducted a search in the PubMed database on governance models. Results Our search resulted in 220 hits, 11 papers included. We sorted these in four health systems Governance takes three different paths. 1) governance of e-health - how governments govern e-health programs through national and regional strategies, standards, incentives, legislation 2) governance through e-health - e-health as a strategic tool to obtain national health policy goals 3) governance in e-health - governance in medical networks initiated bottom-up and run by clinicians. In the Single-Payer we find two papers. Both these describe governance of e-health. When the processes had been running for a period of time it shifted to governance through e-health. Two papers from New Zealand describe top-down governance model of e-health. Under the Multi-Payer health system we find a paper that describes the experiences of realizing a national telehealth network in Australia through a governance model in e-health. Under Unknown health system and national governance models, we include a paper that describes a governance model of e-health in Haiti. Two other papers describe the tension between non-profit and for-profit organizations on access to health data and domain names. The authors questions how governments shall realize governance models which captures these new aspects in healthcare. The second paper describes the challenges faced by the authorities’ governance of the purchase and sale of health domains when public health institutions do not have an overview of this. The papers in this category may question if there is a need for a fourth governance model in e-health on the global level. Conclusions The development of governance models are not static but part of processes and context dependent. Need for a fourth governance model on the global level. Key messages Research has shown that national large-scale e-health projects are rarely defined as successful. Currently scattered knowledge on how large-scale e-health projects that bring economic, clinical and societal benefits are governed.

Evaluation of mortality in bundle branch block patients from an electronic cohort: Clinical Outcomes in Digital Electrocardiography (CODE) study

BackgroundLeft bundle branch block is recognized as a marker of higher risk of death, but the prognostic value of the right bundle branch block in the general population is still controversial. Our aim is to evaluate the risk of overall and cardiovascular mortality in patients with right (RBBB) and left bundle branch block (LBBB) in a large electronic cohort of Brazilian patients. MethodsThis observational retrospective study was developed with the database of digital ECGs from Telehealth Network of Minas Gerais, Brazil (TNMG). All ECGs performed from 2010 to 2017 in primary care patients over 16 years old were assessed. The electronic cohort was obtained by linking data from ECG exams (name, sex, date of birth, city of residence) and those from national mortality information system, using standard probabilistic linkage methods (FRIL: Fine-grained record linkage software, v.2.1.5, Atlanta, GA). Only the first ECG of each patient was considered. Clinical data were self-reported, and ECGs were interpreted manually by cardiologists and automatically by the Glasgow University Interpreter software. Hazard ratio (HR) for mortality was estimated using Cox regression. ResultsFrom a dataset of 1,773,689 patients, 1,558,421 primary care patients over 16 years old underwent a valid ECG recording during 2010 to 2017. We excluded 17,359 patients that didn't have a valid QRS measure from the Glasgow program and 11,091 patients from the control group that had QRS equal or above 120 ms and were not RBBB or LBBB. Therefore, 1,529,971 were included (median age 52 [Q1:38; Q3:65] years; 40.2% were male). In a mean follow-up of 3.7 years, the overall mortality rate was 3.34%. RBBB was more frequent (2.42%) than LBBB (1.32%). In multivariate analysis, adjusting for sex, age and comorbidities, both patients with RBBB (HR 1.32; CI 95% 1.27–1.37) and LBBB (HR 1.69; CI 95% 1.62–1.76) had higher risk of overall mortality. Women with RBBB had an increased risk of all-cause death compared to men (p < 0.001). Cardiovascular mortality was higher in patients with LBBB (HR 1.77; CI 95% 1.55–2.01), but not for RBBB. ConclusionsPatients with RBBB and LBBB had higher risk of overall mortality. Women with RBBB had more risk of all-cause death than men. LBBB was associated with higher risk of cardiovascular mortality.

Tele-electrocardiography and bigdata: The CODE (Clinical Outcomes in Digital Electrocardiography) study

Digital electrocardiographs are now widely available and a large number of digital electrocardiograms (ECGs) have been recorded and stored. The present study describes the development and clinical applications of a large database of such digital ECGs, namely the CODE (Clinical Outcomes in Digital Electrocardiology) study.ECGs obtained by the Telehealth Network of Minas Gerais, Brazil, from 2010 to 17, were organized in a structured database. A hierarchical free-text machine learning algorithm recognized specific ECG diagnoses from cardiologist reports. The Glasgow ECG Analysis Program provided Minnesota Codes and automatic diagnostic statements. The presence of a specific ECG abnormality was considered when both automatic and medical diagnosis were concordant; cases of discordance were decided using heuristisc rules and manual review. The ECG database was linked to the national mortality information system using probabilistic linkage methods.From 2,470,424 ECGs, 1,773,689 patients were identified. After excluding the ECGs with technical problems and patients <16 years-old, 1,558,415 patients were studied. High performance measures were obtained using an end-to-end deep neural network trained to detect 6 types of ECG abnormalities, with F1 scores >80% and specificity >99% in an independent test dataset. We also evaluated the risk of mortality associated with the presence of atrial fibrillation (AF), which showed that AF was a strong predictor of cardiovascular mortality and mortality for all causes, with increased risk in women.In conclusion, a large database that comprises all ECGs performed by a large telehealth network can be useful for further developments in the field of digital electrocardiography, clinical cardiology and cardiovascular epidemiology.

Brazilian National Service of Telediagnosis in Electrocardiography.

Access to specialized care remains unsolved in Brazil. The National Telediagnosis Project was created to expand successful telediagnosis experiences nationwide. The Telehealth Network of Minas Gerais (TNMG) was selected as a reference for tele-electrocardiogram (ECG). We aim to describe the experience of TNMG of developing and implementing the Brazilian National Service of Telediagnosis in Electrocardiography. Implementation planning includes discussion of workflows, standard procedures, responsibility definition for stakeholders, and adaptation of TNMG telediagnosis system. Tele-ECG has been implemented in 79 municipalities in 5 states. In a survey with 152 health professionals, 57% noted that ECG was not available in the local public health system before, 63% indicated tele-ECG service utilization ≥3 days per week, 96% considered the service very useful and 89% were very satisfied with it. In conclusion, the service fills a gap in specialized care in the public system and can improve access to a basic exam in remote and underserved regions.

Revisiting Mackay Online

Revisiting Mackay Online

Mississippi Diabetes Telehealth Network: A Collaborative Approach to Chronic Care Management.

Background/Introduction: Ineffective management of chronic illness and lack of referral sources in underserved areas has contributed to increased health care spending and a decline in quality of life for the affected. In 2016, 15.4% of the adult population of Mississippi had diabetes. Telehealth in the home is a viable way to bring a care team to patients to assist them as they manage their illnesses. The purpose of the study was to determine the relationship between the Mississippi Diabetes Telehealth Network clinical care model and selected diabetes outcomes over time. Methods: A prospective, longitudinal cohort study design evaluated the relationship between using telehealth for chronic care management and diabetes outcomes over a 12-month period. Eligible participants were patients over 18 years old diagnosed with diabetes at a rural health clinic with an hemoglobin A1c (HbA1c) ≥7.0%. Rolling enrollment continued until the pool of eligible participants was depleted. A total of 171 were enrolled. Results: There was a significant difference in HbA1c values from baseline to 3-, 6-, 9-, and 12-month values. A significant difference was found between baseline and 12-month measures for total cholesterol, low density lipoproteins (LDL), high density lipoproteins (HDL), triglycerides, creatinine clearance, glomerular filtration rate, and potassium. There were no differences in baseline and 12-month measures for weight, blood pressure, blood urea nitrogen (BUN), and microalbumin. Discussion/Conclusions: Even with the limited sample size and design, remote patient monitoring and telehealth may be an effective tool for assisting home-based patients in the self-management of diabetes in rural areas. The maximum benefit was achieved after 3-4 months on the program and maintained over the 12-month period.

Postgraduate trainee views on eHealth at a distributed medical campus.

Purpose: e-Health is a rapidly evolving field that cuts across specialties however; there is a gap in development and evaluation of training for postgraduates in residency programs. This is a multicentre, collaborative effort among faculty from the departments of Psychiatry, Geriatrics and Internal Medicine in partnership with Ontario Telehealth Network to assess the needs of postgraduate residents in ehealth and build a pilot program to address identified learning gaps.&#x0D; Methodology: We conducted a needs assessment (Appendix A) through an online survey to investigate the self-perceived knowledge, gaps and barriers to eHealth of medical resident physicians at the McMaster University DeGroote School of Medicine Waterloo Regional Campus (WRC), Kitchener, Ontario, Canada&#x0D; Results: All respondents identified that they would be interested in education in telehealth and all of them felt that they would have to use telehealth in their future practices. However, 83.3% did not feel confident using telemedicine in clinical practice. Based on the results of the needs assessment, we have built a pilot rotation in which postgraduate trainees can practice telehealth skills in an interdisciplinary setting.

Postgraduate trainee views on eHealth at a distributed medical campus.

Purpose: e-Health is a rapidly evolving field that cuts across specialties however; there is a gap in development and evaluation of training for postgraduates in residency programs. This is a multicentre, collaborative effort among faculty from the departments of Psychiatry, Geriatrics and Internal Medicine in partnership with Ontario Telehealth Network to assess the needs of postgraduate residents in ehealth and build a pilot program to address identified learning gaps.&#x0D; Methodology: We conducted a needs assessment (Appendix A) through an online survey to investigate the self-perceived knowledge, gaps and barriers to eHealth of medical resident physicians at the McMaster University DeGroote School of Medicine Waterloo Regional Campus (WRC), Kitchener, Ontario, Canada&#x0D; Results: All respondents identified that they would be interested in education in telehealth and all of them felt that they would have to use telehealth in their future practices. However, 83.3% did not feel confident using telemedicine in clinical practice. Based on the results of the needs assessment, we have built a pilot rotation in which postgraduate trainees can practice telehealth skills in an interdisciplinary setting.

Abstract 16594: Clinical Outcomes in Digital Electrocardiography: Evaluation of Mortality in Atrial Fibrillation (Code Study)

Introduction: Telehealth system is an important tool to improve access and quality to health assistance.Large electrocardiogram (ECG) databases, linked to mortality or hospitalization data, can be useful in determining the prognostic value of ECG markers. Atrial fibrillation (AF) is a public health problem with increasing prevalence as the population ages, associated with cardiovascular mortality and morbidity. Hypothesis: Evaluate the association between the presence of AF with overall and cardiovascular mortality in a large electronic cohort of primary care patients of Minas Gerais. Methods: This is an observational retrospective study. Patients over 16 years old who performed digital electrocardiograms by Telehealth Network of Minas Gerais from 2013 to 2016 were assessed. A probabilistic linkage between data from the national mortality information system and our ECG database was made. Clinical data were self-reported, and ECGs were interpreted by a team of trained cardiologists and automatic software (Glasgow and Minnesota).The diagnosis of AF was considered if there was concordance between the cardiologist′s report and one of the automatic systems. In cases of disagreement, ECGs were reviewed manually.Only the first ECG made was analysed. To assess the relation between AF and mortality, Cox regression was used, adjusted by age, sex and clinical conditions. Results: From a dataset of 1,773,689 patients, 1,075,531 were included. The mean age was 51.4 years, 40.5% male.The prevalence of AF was 1.15%. There were 2.9% deaths for all causes in 2.69 years of mean follow up. In univariate analysis, AF was a risk factor for death from all causes (HR 6.98, 95%CI 6.68-7.28). After adjustment for age, sex and comorbidities, AF remained an independent risk factor for all-cause mortality (HR 2.49; 95% CI 2.39 - 2.61). AF was also a predictor of risk for cardiovascular mortality after adjustment for age, sex and clinical conditions (HR 2.35, 95% CI 2.01-2.73). In multivariate analysis by sex, adjusted for age and comorbidities, AF women had higher risk of death for all causes (HR 3.06; 95% CI 2.86-3.26) than men (HR 2.18; 95% CI 2.06-2.32). There were no difference between sex in cardiovascular mortality (HR 2.34; 95% CI 2.01-2.73 for male sex e HR 2.49; 95% CI 2.14-2.90 for female). Conclusions: AF was a strong predictor of mortality for all causes and cardiovascular mortality in primary care population with increased risk in women for deaths for all cause.

Trust-Based Intrusion Detection and Clustering Approach for Wireless Body Area Networks

For most of the tele-health applications body area networks (BANs) have become a favouring and significant technology. This application domain is exclusive so assuring security and obtaining the trustworthy details of the patients’ physiological signs is difficult. To rectify this issue, an attack-resilient malicious node detection scheme (BAN-Trust) is brought-in in the current system, which can identify the malignant attacks on BANs. In this BAN-Trust scheme, malignant nodes is identified according to the nature acquired through the nodes by their own and approvals shared by various nodes. Nevertheless, BAN-Trust conceives the common behaviour among the nodes and it doesn’t conceive the energy of the nodes and gather the information for measuring the trust. So, here, trust-based intrusion detection and clustering is proposed in order to identify the malignant nodes and broadcast the energy-effective data. In our work, trust-based intrusion detection model is brought-in for identifying the malignant nodes. Different varieties of trusts were conceives, namely energy, data and communication trust, which can be developed among two sensor nodes. Once after identifying the malignant nodes, the rest of the nodes in the network were gathered in order to create the cluster. Every cluster has one cluster head (CH) that is chosen by utilizing the multi objective firefly algorithm. The target function of this system is to reduce the delay, increase the broadcast energy and throughput. The multiple body sensor nodes were in-charge for gathering different varieties of data that were sent to the CH. The CH then forwards the gathered data to the sink and sends the details to the system via gateway. By utilizing a hybrid encryption algorithm, the system’s data is encrypted and forwarded to the hospital server. Decrypting is done on the server side to disclose the exact data. The proposed methodology is executed by utilizing an NS-2 simulator. The experimental output provides that the proposed system accomplishes good performance when distinguished with the current system in terms of precision, recall, throughput, packet delivery ratio and end to end delay.

Telementoring for improving primary care provider knowledge and competence in managing chronic pain: A randomised controlled trial

Introduction Primary care providers are frequently unprepared to manage chronic pain adequately due in part to insufficient professional training. This study evaluated the effect of a telementoring intervention on knowledge and perceived competence related to chronic pain management. Methods The study design was a cluster randomised controlled trial. Primary care clinics that were part of the University of Washington Medicine Telehealth network were the unit of randomization. Primary care providers comprised the intervention group (n = 23) and the control group (n = 18). Providers in the intervention group attended telementoring sessions through the TelePain programme and presented patient cases at the beginning and end of their enrolled patients’ 12-week study period. TelePain sessions included a didactic presentation and telementoring for specific patient cases by a panel of pain specialists from the disciplines of pain medicine, internal medicine, anaesthesiology, rehabilitation medicine, psychiatry, addiction medicine, nursing and complementary and integrative pain management. Providers’ baseline and end-of-study knowledge and perceived competence in managing chronic pain were assessed by three questionnaires: Knowledge and Attitudes Survey Regarding Pain, the KnowPain-12 and the Perceived Competence Scale. Results Knowledge (Z = –0.34, p = 0.97 (Knowledge and Attitudes Survey Regarding Pain) and Z = 0.49, p = 0.62 (KnowPain-12)) and perceived competence (Z = –0.74, p = 0.46) did not increase for providers in the intervention group compared with providers in the control group. These providers attended on average 12.5 sessions (range 0–31) while participating in the study. Discussion Further research is recommended to establish the effectiveness of this telementoring intervention.

Comparison of Inter-hospital Urological Transfers Between a Metropolitan and Rural Tertiary Care Institution

IntroductionUrological services are not available at all hospitals, and the transfer of patients between medical centers provides an avenue to meet medical need. In rural areas, patients often visit community medical centers with limited services and require transfer. We aimed to compare the transfer process between two tertiary care institutions, one serving a metropolitan and the other a rural population. MethodsTwo academic medical centers were selected, one which primarily services a large metropolitan city center, while the second primarily services a large rural population. Transfer logs for the urological services from September 2015 to September 2017 were compared. Records were examined for an affiliated urologist at the originating hospital, distance traveled, reason for transfer, and the need for surgical management. Variables were analyzed using descriptive statistics. ResultsOverall, 606 transfers were included, with 16% (97/606) transferred to the metropolitan center and 84% (509/606) to the rural center. Patients transferred to the rural center were younger (53.3 versus 61.9; p<0.001) and traveled further (64.2 versus 36.5 miles; p<0.001) compared to the metropolitan site. Hospitals referring patients to the rural center were less likely to have an affiliated urologist (66.7% versus 91.1%; p=0.008). 38% of patients were surgically managed which was not different between the institutions. ConclusionsDifferences exist between transfers to the rural and metropolitan center, suggesting an increased need for basic urological services in the surrounding rural community. At both centers, most patients did not require a procedure and might avoid transfer through telehealth or collaborative care networks.

Using Teleneurology to Deliver Chronic Neurologic Care to Rural Veterans: Analysis of the First 1,100 Patient Visits.

A challenge confronting the United States is delivery of quality specialty healthcare to citizens living in rural areas. The Veterans Administration (VA) developed a large national telehealth network to address 5.2 million rural veterans. New Mexico's Albuquerque VA Neurology Service developed a teleneurology program for their rural veterans. This article analyzes our first 1,100 teleneurology patient visits. Veterans living in remote areas of New Mexico, southern Colorado, eastern Arizona, and western Texas were offered follow-up teleneurology care at 16 rural VA community-based outpatient clinics (CBOCs) following an initial evaluation at the Albuquerque VA neurology outpatient clinic. Surveys were sent after all teleneurology visits focused on quality of care, ease of communication, satisfaction, and staff's ability to deliver same quality care as in person. Problems encountered, differences between face-to-face clinics and teleneurology, and cost savings were examined. Regarding the 701 (64%) returned surveys, we found 90% perceived they received good care, 91% felt there was good communication, 88% liked the convenience, and 87% reported they desired to continue teleneurology care. Ninety-six percent reported saving time, money, or both through CBOC visits instead of driving to Albuquerque. All providers felt that they could deliver excellent care through teleneurology. We found emergency room visits for neurologic problems was similar for both groups. Our rural veteran patients and neurology staff overwhelmingly found high quality patient care can be delivered via teleneurology for a variety of chronic neurologic problems and was comparable to care delivered in neurology face-to-face clinics.

Meeting the challenge for effective antimicrobial stewardship programs in regional, rural and remote hospitals - what can we learn from the published literature?

Antimicrobial resistance (AMR) has been recognised as an urgent health priority, both nationally and internationally. Australian hospitals are required to have an antimicrobial stewardship (AMS) program, yet the necessary resources may not be available in regional, rural or remote hospitals. This review will describe models for AMS programs that have been introduced in regional, rural or remote hospitals internationally and showcase achievements and key considerations that may guide Australian hospitals in establishing or sustaining AMS programs in the regional, rural or remote hospital setting. A narrative review was undertaken based on literature retrieved from searches in Ovid Medline, Scopus, Web of Science and the grey literature. 'Cited' and 'cited by' searches were undertaken to identify additional articles. Articles were included if they described an AMS program in the regional, rural or remote hospital setting (defined as a bed size less than 300 and located in a non-metropolitan setting). Eighteen articles were selected for inclusion. The AMS initiatives described were categorised into models designed to address two different challenges relating to AMS program delivery in regional, rural and remote hospitals. This included models to enable regional, rural and remote hospital staff to manage AMS programs in the absence of on-site infectious diseases (ID) trained experts. Non-ID doctor-led, pharmacist-led and externally led initiatives were identified. Lack of pharmacist resources was recognised as a core barrier to the further development of a pharmacist-led model. The second challenge was access to timely off-site expert ID clinical advice when required. Examples where this had been overcome included models utilising visiting ID specialists, telehealth and hospital network structures. Formalisation of such arrangements is important to clarify the accountabilities of all parties and enhance the quality of the service. Information technology was identified as a facilitator to a number of these models. The variance in availability of information technology between hospitals and cost limits the adoption of uniform programs to support AMS. Despite known barriers, regional, rural and remote hospitals have implemented AMS programs. The examples highlighted show that difficulty recruiting ID specialists should not inhibit AMS programs in regional, rural and remote hospitals, as much of the day-to-day work of AMS can be done by non-experts. Capacity building and the strengthening of networks are core features of these programs. Descriptions of how Australian regional, rural and remote hospitals have structured and supported their AMS programs would add to the existing body of knowledge sourced from international examples. Research into AMS programs predominantly led by GPs and nursing staff will provide further possible models for regional, rural and remote hospitals.

CTN: Advancing Rural and Underserved Healthcare in California

No abstract available.&#x0D; Editor’s note: In this TMT interview, Mr. Eric Brown, President and CEO of the California Telehealth Network (CTN), discusses the development and the role of CTN in providing advanced information technologies and services to medically underserved and rural Californians. An independent non-profit 501c3, CTN is one of the largest FCC-funded statewide telehealth networks in the nation, connecting over 750 healthcare provider locations.&#x0D;

Technology's Role in Quality Improvement and Operational Efficiency

Technology for technology's sake is never a good idea. There must be a purpose behind it. It must help us do our jobs better. Technology allows healthcare to remain affordable and, as such, accessible. Technology must increase access to care, improve safety, make test results more reliable, and help teams communicate better for a seamless care experience.Avera Health, a health system based in Sioux Falls, South Dakota, comprises 330 facilities in 100 communities in five states. Sponsored by the Benedictine and Presentation Sisters, Avera is a healthcare ministry whose employees deliver high-quality care with compassion. We have been early innovators in using technology to deliver a high standard of service.Avera has been nationally recognized for its innovation. For 18 of the past 19 years, the system has been named to Hospitals & Health Networks magazine's list of Health Care's Most Wired and has been designated as "advanced" for reasons that include the development of the most extensive telehealth network serving rural healthcare facilities. Avera also won the Most Wired Innovator Award in 2011 and 2012. Avera's flagship 545-bed tertiary facility, Avera McKennan Hospital & University Health Center, has received Stage 7 recognition from HIMSS Analytics.Avera leaders have developed a spirit of inquiry and a culture of innovation. We have fostered change by aligning our care into service lines that help ensure that wherever people walk in our doors, they will receive the same quality care. In several cases, we have innovated through strategic partnerships. In this article, we describe how technology helps sustain our culture of innovation.