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Category: Foundational

Pipeline: Wellness – Primary Health

Provider: Avel eCare

Contact Information:
Liz Tofteland, ND eCare Program Manager

Sheila Freed, Director of School Health, Avel eCare

What it is:
The ND eCare School Health Program aims to improve access to healthcare for all K-12 students in North Dakota by providing safe, effective care from a registered nurse via telehealth. The eCare School Health Program is currently serving 23 districts and more than 40 schools in North Dakota.

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When chronic and acute healthcare needs are met, students are proven to miss fewer days of school and show improved academic performance. 

School nurses play an integral role in keeping students healthy; however, in 2015, the North Dakota school nurse-to-student ratio was 1:1,748. The American Academy of Pediatrics recommends a ratio of 1:750. 

The disparity in access is especially dire in rural communities, where geographic, staffing, and monetary constraints prevent schools from hiring full- or part-time nurses. 

The Avel eCare School Health Program was created in 2015 to help bridge the gap between rural students and healthcare. After a successful pilot program in Sioux Falls, the eCare School Health Program was expanded to serve schools across the Dakotas, with more than 40 North Dakota districts currently served. 

Using high-definition video technology, students are connected directly with a registered nurse who can provide support for unscheduled, acute needs, such as injuries and illness, as well as regular care for chronic conditions, like diabetes and life-threatening allergies. Additionally, nurses can assist school staff in developing emergency health plans and provide medical advice for 504 and Individualized Education Program (IEP) plans.

“We don’t just see the kids; we bring a whole school health system to them,” said Sheila Freed, Director of School Health at Avel eCare.

Through this program, schools and their students can experience the benefits that come with having immediate access to a registered nurse at a fraction of the cost of hiring a full-time school nurse. All new schools pay an implementation fee of 2,500 dollars, while additional costs are determined based on school enrollment.

Freed, a school nurse herself, has witnessed first-hand both the gap in school nursing and the effectiveness of the ND eCare School Health Program at bridging that gap. One student, a six-year-old at a rural North Dakota school, was recently diagnosed with diabetes. Without a school nurse available to support the student, the public health nurse referred the school to Avel eCare. 

During her initial interaction with the ND eCare School Health Program, the student’s mother was understandably nervous about handing her son’s care over to a virtual nurse. However, after more in-depth conversations about the program and the student’s first on-camera meeting with his assigned nurse, his mother said: It went so much better than I would’ve ever guessed. 

“It’s all about the relationships and the connections. We understand there are real people on the other side of the camera,” Freed said. “As you make decisions with the kids in mind, if you do what is best for the school, you cannot go wrong.”


Schools interested in learning more and implementing eCare at their school are encouraged to contact Liz Tofteland to set up a noncommittal demonstration meeting:

Liz Tofteland, ND eCare Program Manager
Central Regional Education Association


We are a Consortium representing a variety of ND schools and organizations who are passionate about helping ND students and families succeed.


We partner with local leaders to coordinate comprehensive supports in areas such as wellness , workforce readiness, and academic enrichment to help students, families, and communities thrive.


Students cannot learn when their basic needs are not met. Not all schools have the resources to meet all needs. NDFSCS supports schools and community partners in navigating these challenges together.