Project ECHO: Improving Access to Speciality Care
By Art Kelley, MD
Chief Medical Officer | Emtiro Health
In 2003, Dr. Sajeev Arora, a liver specialist at the University of New Mexico School of Medicine, realized that his specialty clinic for the treatment of Hepatitis C was overrun with patients in need of care. Wait lists were long and many of the patients who were being seen struggled to keep their appointments because of the long distances they had to travel to Albuquerque to receive Interferon, a complicated and sole treatment available at the time.
He and his colleagues reasoned that with the backup of experts at the UNM School of Medicine, primary care physicians might be convinced to care for patients with Hepatitis C in their practices, greatly increasing the adherence of patients to the treatment regimen.
Project ECHO was born.
Using case-based learning via videoconferencing, primary care physicians receive evidence-based treatment recommendations on their Hepatitis C patients. This, along with didactics on best practices for Hepatitis C treatment, enabled these primary care physicians to achieve the same treatment outcomes as their specialist colleagues at the University. Since this first project, the ECHO model has expanded to include other chronic illnesses through ECHO projects in the United States and countries around the world. (https://echo.unm.edu/).
What are the essential components of an ECHO model?
- Use of Technology. Participants (spoke learners) are brought together with specialists (hub experts) via HIPAA compliant videoconferencing software.
- Case–Based Learning. Spoke learners present cases on the specific illness that is the focus of a particular ECHO project to the hub experts. A discussion ensues that involves both the participants and the experts that ultimately results in treatment recommendations for each case presented.
- Dissemination of Best Practices. Each ECHO session has a brief didactic that provides participants with information on what constitutes gold standard care for the illness in question. Some ECHO projects can provide continuing education credits for participants. The overarching goal of the didactics is to decrease variability in care to achieve better patient outcomes and to increase the sense of self-efficacy among clinicians.
- Data Tracking. All patients discussed in an ECHO session are de-identified to comply with HIPAA regulations, but this de-identified data is collected and reviewed to improve the functioning of the ECHO project. Attendance records, credentials of the participants, and organizations represented by the participants are also collected and provided to Project ECHO at the University of New Mexico to monitor the program.
ECHO projects don’t just help clinicians. Patients also benefit. Going back to the Hepatitis C example, patients who lived in areas far away from the University clinic no longer had the burden of the long hours and expense of traveling to Albuquerque, thus increasing their treatment adherence. ECHO projects are one of the solutions to the specialist access issue in rural areas.
Those who wish to establish an ECHO project that is in fidelity to the national program and can rely on the national program for ongoing support and consultation send a core team to the University of New Mexico for three days of training in the model. Our parent companies have formed the Northwest | Partnership ECHO and its core team members have received the training necessary to have the Northwest | Partnership recognized as a replication partner of Project ECHO. A Substance Use in Pregnancy ECHO is its first ECHO clinic. Twice monthly, participants present cases of pregnant women who have substance use issues to a hub of experts that consists of addiction psychiatrists, substance abuse counselors, high risk pregnancy obstetricians, and a primary care physician who then offer treatment recommendations. Currently the Northwest|Partnership ECHO is working to establish a Child Mental Health ECHO that will support primary care physicians as they treat children and adolescents with behavioral health issues.
For more information on the Northwest|Partnership ECHO please visit either of our parent organizations’ website:
Arora et.al., Project ECHO: a tele-mentoring network model for continuing professional development, Journal of Continuing Education in the Health Professions, 37(4), 2017, pp. 239-244.