Emergency physicians sitting in Sioux Falls, S.D., have examined more than 1,000 patients in 27 rural hospitals—some of them hundreds of miles away—in the past 18 months.

Through the eEmergency service provided by Avera Health, a regional health system serving South Dakota and five adjacent states, critical access and other small hospitals get round-the-clock support for the nurses who staff their emergency departments.

"When a patient arrives in the ED, the nurses hit a button and two-way video is available so they have a physician there immediately with them," says Deanna Larson, Avera's vice president of quality initiatives.

The remote emergency care is the fastest-growing of Avera Health's suite of telehealth services, with at least six new hospitals coming online this year. Community hospitals pay Avera a monthly access fee based on the size of the hospital.

"It's been like a proverbial prairie wildfire," says Jim Veline, Avera Health's senior vice president and chief information officer.

Veline believes that telehealth services will continue to grow, not just for Avera, but for other regional health systems. The Affordable Care Act advances telehealth in several ways. For example, it directs the new Center for Medicare & Medicaid Innovation to explore a care model that uses electronic monitoring to facilitate inpatient care. And in May, CMS issued a final rule making it significantly easier for hospitals to tap into remote physicians.

Previously, CMS required hospitals utilizing telemedicine to follow the same credentialing procedures with remote doctors as it did with local ones. The new regulations, which take effect in early July, allow the hospital to rely on the credentials from the physician's home facility. Medical staff at the remote hospital still must grant privileges, but can do so with much greater ease. State licensure barriers remain, though, when it comes to letting physicians conduct telemedicine across state lines.

"As we see the need for this to grow across the country, we would like to see the government make it a little easier," Veline says.