Beginning in 1993, Avera offered eCARE Specialty Clinic services to rural, frontier and critical access hospitals that were part of the Avera Health system. Ten years later, Avera eCARE expanded to provide eCARE ICU, the first 24-hour, on-demand service that allows staff at partner facilities to connect virtually via a video and audio call for immediate assistance from board-certified providers. In addition, Avera eCARE delivered 24/7 access to a wide range of medical specialists and referrals to specialty care for a growing number of underserved populations and communities. Then, in 2009, through a grant from The Leona M. and Harry B. Helmsley Charitable Trust, Avera eCARE launched eCARE Emergency and eCARE Pharmacy for all of Avera’s rural hospitals. Additional funding from the Helmsley Charitable Trust and other sources allowed expansion to over 200 Avera facilities across eight states and the ability to serve partners outside Avera Health. By 2012, Avera eCARE services were available for long-term care and correctional facilities. At Avera eCARE, their telemedicine professionals work together 24/7 in the eHELM, their virtual hospital hub, also created in 2012 with the assistance of the Helmsley Charitable Trust. By staffing their central facility around the clock, their partners and patients benefit from the multidisciplinary collaboration of medical specialists within their telemedicine teams 24/7/365.