Move knowledge rather than patients: build your primary care capacity through expert clinical specialty mentoring and education

Adopting the ECHO model™ (Extension for Community Healthcare Outcomes)

  • Erika Harding, MA ECHO Institute, University of New Mexico Health Sciences Center
AMA in partnership with
CME Credits: 0.5
Adopting the ECHO model™ (Extension for Community Healthcare Outcomes)

How will this module help me build primary care capacity in my practice?

  1. Seven STEPS to incorporate the Project ECHO® model in your practice
  2. Answers to commonly asked questions about adopting the model
  3. Tools and resources to help your team increase access to care for your patients

CME accreditation information 

Increasing administrative responsibilities—due to regulatory pressures and evolving payment and care delivery models—reduce the amount of time physicians spend delivering direct patient care. Primary care physicians and other clinicians can learn to provide excellent specialty care directly to patients in their own practices. By connecting with a subspecialty team of experts and building a community of practice via telemedicine, primary care physicians are able to increase knowledge, mastery and joy of medical practice.

Adopting the ECHO model™ (Extension for Community Healthcare Outcomes)
Release Date: August 31, 2016
End Date: August 31, 2019

Objectives

At the end of this activity, participants will be able to:

  1. Describe the benefits of Project ECHO®.
  2. Select a specialty topic area.
  3. Participate in a teleECHO clinic session.

Target Audience

This activity is designed to meet the educational needs of practicing physicians.

Statement of Need

In some regions, patients often wait weeks or even months to see a specialist. Visiting a specialist may also require them to travel great distances. In some situations, patients may be unable to travel and therefore do not receive the additional specialty care they need. This can be incredibly frustrating and disheartening for both clinicians and patients, particularly when patients with chronic conditions might need to see a specialist several times a year. This module will educate physicians on ways to build specialty care access through expert specialty mentoring and education via telemedicine.

Statement of Competency

This activity is designed to address the following ABMS/ACGME competencies: patient care, practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice and also address interdisciplinary teamwork and quality improvement.

Accreditation Statement

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The American Medical Association designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claiming Your CME Credit

To claim AMA PRA Category 1 Credit™, you must 1) view the module content in its entirety, 2) successfully complete the quiz answering 4 out of 5 questions correctly and 3) complete the evaluation.

Planning Committee

  • Alejandro Aparicio, MD, Director, Medical Education Programs, AMA
  • Rita LePard, CME Program Committee, AMA
  • Becca Moran, MPH, Program Administrator, Professional Satisfaction and Practice Sustainability, AMA
  • Bernadette Lim, Program Administrator, Professional Satisfaction and Practice Sustainability, AMA
  • Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, AMA
  • Christine Sinsky, MD, Vice President, Professional Satisfaction, AMA
  • Allison Winkler, MPH, Senior Practice Development Specialist, Professional Satisfaction and Practice Sustainability, AMA

Author(s)

  • Erika Harding, MA, Director of Replication Initiatives, ECHO Institute™, University of New Mexico Health Sciences Center

Faculty

  • Leslie A. Hayes, MD, Family Physician, El Centro Family Health
  • Vanessa Jacobsohn, MD, Director of Primary Care at UNM's Addiction and Substance Abuse Program, University of New Mexico
  • Becca Moran, MPH, Program Administrator, Professional Satisfaction and Practice Sustainability, AMA
  • Christine Sinsky, MD, Vice President, Professional Satisfaction, AMA
  • Allison Winkler, MPH, Senior Practice Development Specialist, Professional Satisfaction and Practice Sustainability, AMA

About the Professional Satisfaction, Practice Sustainability Group

The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, "Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy," and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.

Disclosure Statement

The content of this activity does not relate to any product of a commercial interest as defined by the ACCME; therefore, neither the planners nor the faculty have relevant financial relationships to disclose.

Media Types

This activity is available to learners through Internet and Print.

Hardware/software Requirements

Adobe Flash 9.0.115 or above
Audio speakers or headphones
Screen resolution of 800X600 or higher
MS Internet Explorer 8.0 or higher, Firefox, Opera, Safari, etc.
Adobe Reader 5.0 or higher

The project described was supported by Funding Opportunity Number CMS-1L1-15-002 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

References

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  2. Project ECHO: Spreading Access to Specialty Healthcare. http://www.youtube.com/watch?v=2lBfyOlL4_s. Accessed May 7, 2016.
  3. Project ECHO, Changing the World Fast. https://youtu.be/VAMaHP-tEwk. Accessed May 7, 2016.
  4. Bornstein D. The Power to Cure, Multiplied. New York Times. June 11, 2014. http://opinionator.blogs.nytimes.com/2014/06/11/the-doctor-will-stream-to-you-now/?_r=0. Accessed May 7, 2016.
  5. Wong JB, et al. Cost-effectiveness of hepatitis C treatment by primary care providers supported by the Extension for Community Healthcare Outcomes (ECHO) model. Presented at: 64th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2013; November 1-5, 2013; Washington, DC. Hepatology. 2013;58(Suppl S1):208A-1309A.
  6. Arora S, Kalishman S, Thronton K, et al. Expanding access to hepatitis C virus treatment—Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care. Hepatology. 2010;52(3):1124-1133. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795614/.
  7. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364:2199-2207. http://www.nejm.org/doi/pdf/10.1056/NEJMoa1009370.
  8. Arora S, Kalishman S, Dion D, et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood). 2011;30(6):1176-1184. http://content.healthaffairs.org/cgi/pmidlookup?view=long&pmid=21596757.
  9. Bankhurst A, Arora S, Kalishman S, et al. Expanding access in rheumatology specialty care in New Mexico via an innovative community outreach program. Presented at: American College of Rheumatology/Association of Rheumatology Health Professionals Annual Scientific Meeting; November 9-14, 2012; Washington, D.C. Arthritis Rheum. 2012;64(Suppl10):2028. http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=789&id=102767#.
  10. Catic, A., Mattison MLP, Bakaev I, Morgan M, Monti SM, Lipsitz L. ECHO-AGE: A video-consultation program to bring geriatric expertise to long-term care. JAMDA. 2014;15:938-942. http://www.bidmc.org/~/media/Files/Centers%20and%20Departments/Medicine/Gerontology/ECHO/Catic%20ECHO-AGE%20JAMDA%202014.pdf.
  11. Catic AG, Mattison ML, Bakaev I, Morgan M, Monti SM, Lizsitz L. ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues. J Am Med Dir Assoc. 2014;15(12):938-942. http://www.jamda.com/article/S1525-8610(14)00547-7/abstract.
  12. Colleran, K et al. Building capacity to reduce disparities in diabetes: training community health workers using an integrated distance learning model. Diabetes Educ. 2012;38(3):386-396. http://tde.sagepub.com/content/38/3/386.long.
  13. Cordasco KM, Zuchowski J, Hamilton AB, Knapp H, Saavedra JO, Washington DL. VHA's comprehensive women's health SCAN-ECHO program: lessons learned. Presented at: 37th Annual Meeting of the Society of General Internal Medicine; April 23-26, 2014; San Diego, CA. J Gen Intern Med. 2014;29(Suppl 1):1–545. http://link.springer.com/article/10.1007/s11606-014-2834-9.
  14. Deming P, Anderson J, Dodd M, et al. Project ECHO: a novel model for clinical pharmacists in a multidisciplinary Telehealth care network for rural and underserved communities [abstract 224]. 2013 American College of Clinical Pharmacy Annual Meeting; October 13-16, 2013; Albuquerque, NM. Pharmacotherapy. 2013;33(10):e182-e299. https://www.accp.com/docs/meetings/abstracts/2013_annual.pdf.
  15. Davis R, Sauerwein T, Morrow C, Watson N, True M. Air Force Diabetes Center of Excellence Project ECHO: Successful telemedicine with a global reach. Presented at: American Diabetes Association 75th Scientific Sessions; June 5-9, 2015; Boston, MA; Abstract 779-P. Diabetes. 2015;64(Suppl 1):A187-A235. http://diabetes.diabetesjournals.org/content/64/Supplement_1/A187.full.pdf+html?sid=ba07d26e-d4f3-4703-a6cb-e8923b76a8ae.
  16. Dubin RE, Flannery J, Taenzer P, et al. ECHO Ontario Chronic Pain & Opioid Stewardship: Providing access and building capacity for primary care providers in underserviced, rural, and remote communities. Stud Health Technol Inform. 2015;209:15-22. http://ebooks.iospress.nl/publication/39206.
  17. Frank JW, Carey EP, Fagan KM, et al. Evaluation of a telementoring intervention for pain management in the Veterans Health Administration. Pain Med. 2015;16(6):1090-1100. http://painmedicine.oxfordjournals.org/content/16/6/1090.long.
  18. Gordon SE, Monti SM, Catic AG, et al. Project ECHO-AGE and Nursing Home Quality of Care. JAMDA. 2015;16(3):B27-B28. http://www.jamda.com/article/S1525-8610(15)00062-6/abstract.
  19. Harkins M, Raissy H, Moseley K, Luttecke K, Arora S. Project ECHO: Improving asthma care in New Mexico with telehealth technology. Presented at: CHEST 2011 Annual Meeting; October 22-26, 2011; Honolulu, HI. CHEST. 2011;140(R_Meeting_Abstracts):861A. http://journal.publications.chestnet.org/article.aspx?articleID=1045649.
  20. Ho M, Aron D, Sales AE, et al. The VA's specialty care transformational initiatives to improve access and delivery of specialty care. Presented at: 36th Annual Meeting of the Society of General Internal Medicine; April 24-27, 2013; Denver CO. J Gen Intern Med. 2013;28(Suppl 1):1-489. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654146/.
  21. Katzman JG, Comerci G, Duhigg D, Boyle JG, Olivas C. UNM ECHO-Pain and Headache Program. Presented at: 54th Annual Scientific Meeting of the American Headache Society; June 21-24, 2012; Los Angeles, CA. Headache. 2012;52(5):862-914. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2012.02174.x/epdf.
  22. Katzman JG. Making connections: using telehealth to improve the diagnosis and treatment of complex regional pain syndrome, an underrecognized neuroinflammatory disorder. J Neuroimmune Pharmacol. 2013;8(3):489-493. http://link.springer.com/article/10.1007%2Fs11481-012-9408-6.
  23. Katzman JG, Comerci G Jr., Boyle JF, et al. Innovative telementoring for pain management: project ECHO pain. J Contin Educ Health Prof. 2014;34(1):68-75.
  24. Kauth MR, Shipherd JC, Lindsay JA, Kirsh S, Knapp H, Matza L. Teleconsultation and training of VHA providers on transgender care: implementation of a multisite hub system. Telemed J E Health. 2015;21(12):1012-1018. http://online.liebertpub.com/doi/10.1089/tmj.2015.0010.
  25. Khatri K, Haddad M, Anderson D. Project ECHO: replicating a novel model to enhance access to hepatitis C care in a community health center. J Health Care Poor Underserved. 2013;24(2):850-858. http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v024/24.2.khatri.html.
  26. Knoefel J, Herman C. Dementia care training for primary care providers: Project ECHO™. Presented at: American Academy of Neurology Meeting; April 15-18, 2015; Washington DC; P6.182. Neurology. 2015;84(14 Supplement). https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/7.Conferences/1.CONFERENCES/1.Annual_Meeting/
    15AM%20AbstractListing.pdf
    .
  27. Mitruka K, Thornton K, Cusick S, et al. Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model: Arizona and Utah, 2012–2014. MMWR Morb Mortal Wkly Rep. 2014;63(18):393-398. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a2.htm.
  28. Moore A, Manch RA. Synchronous cohorts: a novel variation to the Project ECHO approach to hepatitis C treatment. Presented at: 64th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2013; November 1-5, 2013; Washington, DC. Hepatology. 2013;58(Suppl S1):208A-1309A. http://liverlearning.aasld.org/aasld/2013/thelivermeeting/36991/
    ann.moore.synchronous.cohorts.a.novel.variation.to.the.project.echo.approach.html?f=m2t1358
    .
  29. Salgia RJ, Mullan PB, McCurdy H, Sales A, Moseley RH, Su GL. The educational impact of the Specialty Care Access Network–Extension of Community Healthcare Outcomes Program. Telemed J E Health. 2014;20(11):1004-1008. http://online.liebertpub.com/doi/abs/10.1089/tmj.2013.0302.
  30. Scott JD, Unruh KT, Catlin MC, et al. Project ECHO: a model for complex, chronic care in the Pacific Northwest region of the United States. J Telemed Telecare. 2012;18(8):481-484. http://jtt.sagepub.com/content/18/8/481.long.
  31. Socolovsky C, Masi C, Hamlish T, et al. Evaluating the role of key learning theories in ECHO: a telehealth educational program for primary care providers. Prog Community Health Partnersh. 2013;7(4):361-368. http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/progress_in_community_health_partnerships_research_education_and_action/v007/
    7.4.socolovsky.html
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  32. Su GL, et al. Implementation of the first Department of Veterans Affairs Specialty Care Access Network-Extension of Community Healthcare Outcomes (SCAN-ECHO) program for chronic liver disease. Presented at: 63rd Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2012; November 9-13, 2012; Boston, MA. Hepatology. 2012;56(Suppl S1):191A-1144A. http://onlinelibrary.wiley.com/doi/10.1002/hep.26040/abstract.
  33. Watts SA, Roush L, Julius M, Sood Al. Improved glycemic control in veterans with poorly controlled diabetes mellitus using a Specialty Care Access Network-Extension for Community Healthcare Outcomes model at primary care clinics. J Telemed Telecare. 2015 Aug 6 [epub ahead of print]. http://jtt.sagepub.com/content/early/2015/08/04/1357633X15598052.long.
  34. Wong JB, et al. Cost-effectiveness of hepatitis C treatment by primary care providers supported by the Extension for Community Healthcare Outcomes (ECHO) model. Presented at: the 64th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2013; November 1-5, 2013; Washington, DC. Hepatology. 2013;58(Suppl S1):208A-1309A. http://onlinelibrary.wiley.com/doi/10.1002/hep.26727/abstract.

Introduction

Primary care physicians (PCPs) and other clinicians can learn to provide excellent specialty care directly to patients in their own practices. In the Project ECHO (Extension for Community Healthcare Outcomes) model, clinicians attend teleECHO™ clinic sessions, where they connect with a subspecialty team of experts (referred to as a "hub") and with other clinicians (the "spokes") to build a community of practice, learning, and support. This approach saves time, adds convenience and improves treatment adherence for patients. It also increases the knowledge, mastery and joy of medical practice for clinicians.

Move knowledge rather than patients #STEPSforward

  • Why Project ECHO?

    In some regions, patients often wait weeks or even months to see a specialist. Visiting a specialist may also require them to travel great distances. In some situations, patients may be unable to travel and therefore do not receive the additional specialty care they need. This can be incredibly frustrating and disheartening for both clinicians and patients, particularly when patients with chronic conditions might need to see a specialist several times a year.

  • What is Project ECHO?

    Project ECHO is a lifelong learning and guided practice model developed precisely to address these concerns. The model has expanded to more than 83 hub partners across 13 countries worldwide and covers more than 49 clinical topics.

    Project ECHO was initiated in 2003 in response to extremely long waits for hepatitis C care and a lack of specialty clinicians in the state of New Mexico. A prospective cohort analysis of the initial Project ECHO hepatitis C virus (HCV) program demonstrated that the model is a viable and effective mechanism for treating HCV infection in underserved communities.3

  • How does Project ECHO work?

    A teleECHO clinic session is, essentially, a virtual grand rounds. Clinicians from multiple locations connect at regularly scheduled times with a multidisciplinary team of specialists using low-cost, multi-point videoconferencing. During teleECHO clinic sessions, PCPs and other clinicians present patient cases to the specialist expert team who then mentors the clinicians on the management of patients with common complex conditions. Everyone learns from each other's cases, similar to what would occur in a grand rounds or tumor board.

    These case-based discussions are supplemented with short didactic presentations to improve content knowledge and share evidence-based best practices. Clinicians can connect to a teleECHO clinic that is focused on a complex condition that is of interest to them. Participation is usually offered free of charge.

Project ECHO is not just a learning and mentoring network; it is also a professional community. Participants are encouraged to ask questions, provide input and guidance to one another, and engage actively in discussions, both during and after a teleECHO clinic session.

Project ECHO can exponentially increase a practice’s workforce capacity to provide specialty care by moving knowledge rather than moving patients. Over time, primary care clinicians operate with increased independence as their knowledge, skills and self-efficacy grow. Implementation of this model has also revealed that when patients are treated in their local communities by clinicians they know and trust, it enhances their adherence to treatment and follow-up care. The Project ECHO model has also been shown to improve clinician professional satisfaction.

ECHO is really the main inspiration I have in my professional life today.

—Dr. Henry Cohen, Uruguay

Seven STEPS to incorporate the Project ECHO model in your practice:

  1. Learn more about the Project ECHO model.
  2. Identify topic areas where there is a need for increased access to specialty care OR areas in which you are particularly interested in gaining deeper learning and specialization.
  3. Connect with Project ECHO hubs that offer training in your clinical area of interest.
  4. Join a teleECHO clinic session in your clinical area of interest to observe the format firsthand and learn from the didactic presentations.
  5. Present patient cases in a teleECHO clinic session.
  6. Apply what you’ve learned to treat patients in your practice.
  7. Continue to participate in teleECHO clinic sessions to refine your skills, presenting patient cases as needed.
  1. 1

    Learn more about the Project ECHO model.

    TEDxABQ: Project ECHO – Changing the World, FAST

    Four principles comprise the Project ECHO model. The combination of these principles results in a unique and successful approach for improving clinician satisfaction, enhancing clinician knowledge and self-efficacy, and improving patient satisfaction and outcomes:

    1. Use technology to leverage the expertise of a multidisciplinary team.
    2. Share best practices to reduce disparities and standardize care.
    3. Leverage case-based learning and guided practice to master complex cases.
    4. Apply web-based tools to monitor outcomes.

    The model is a low-cost, high-impact intervention that links primary care clinicians with expert interdisciplinary teams in other specialties through teleECHO clinics. Experts mentor their primary care colleagues to manage complex patient cases. Expertise is shared via case-based learning, guidance, feedback and didactic education.

  • What makes Project ECHO a unique approach to developing the skills to provide additional specialty care in my practice?

    The heart of the Project ECHO model is its hub-and-spoke knowledge-sharing networks led by expert teams (the “hubs”) who use videoconferencing to conduct virtual clinics with community clinicians (the “spokes”). Primary care doctors, nurses and other clinicians learn to provide excellent specialty care in areas of interest or need to patients in their own communities. They can connect on a regular basis to build a community of practice, learning and support and develop professional relationships that can last a lifetime.

  • How is the Project ECHO model different from traditional telemedicine?

    This model is not “traditional telemedicine” where the specialist assumes care of the patient, but instead is a guided practice model where the PCP retains responsibility for managing the patient. Specialists serve as mentors, training the primary care clinicians to deliver care in areas outside their expertise. Over time, the clinicians operate with increased independence as their knowledge, skills and self-efficacy grow.

  • Where can I learn more about the Project ECHO model and how I can apply it in my practice?

    You are encouraged to join a free Project ECHO introduction to learn more about the model and how it has been applied in the U.S. and worldwide, and to start thinking about how it might address healthcare challenges in your own clinic. The introduction gives an overview of the Project ECHO model, the rationale for its development, evidence showing the benefits to patients and clinicians, a review of the methods and principles of the model, and thoughts about how to apply it in your practice, based on the experience of the 83 hub partners currently operating in 12 countries.

  • Why should I or my practice consider participating in a teleECHO clinic? What are the benefits?

    The teleECHO clinic is a unique tool that enables clinicians to treat patients with common complex conditions rather than referring them to an outside specialist who might have limited availability or be far away, requiring patients to travel long distances. The Project ECHO model increases patient retention and satisfaction by keeping health care within the local community whenever possible. This increases access to, and reduces wait times for, specialty care.

    • Physician development and retention: Through Project ECHO, primary care clinicians acquire new skills and competencies, expanding access to care for their patients. They also become part of a community of learners, increasing their professional satisfaction and decreasing feelings of professional isolation. At the level of the practice, this means that clinicians are more productive and stay in their positions longer.
    • Continuous learning: Clinicians can enjoy no-cost access to continuing education opportunities and specialist consultations during teleECHO clinic sessions. This enables practices and clinicians to be part of a knowledge network.
    • Increased efficiency: Project ECHO has allowed practices to see more patients and to better utilize their staff to serve more patients overall. The model places practices within a professional network through which they can provide local specialty services to patients, rather than relying on a lengthy referral process.
    • Improved quality of care: Implementing “best practices” for complex medical conditions enhances care quality and strengthens the health system as a whole. This model also complements accountable care and medical home models.
    • Improved patient satisfaction: Project ECHO empowers clinicians with the right knowledge to provide the right care in the right place at the right time. This benefits patients in several ways, including: improving access to care, reducing travel costs, reducing unnecessary testing, and improving quality of care (equal to or better than care delivered at a regional specialty site). Patients receive the overall benefit of getting the appropriate intervention earlier than they would through the traditional referral process.
    • Improved patient outcomes: The Project ECHO model dramatically improves health outcomes for patients while bolstering patient retention and satisfaction. When a local health center adopts the model, patients with a wide range of chronic, complex conditions can be treated close to home without waiting months for an appointment. Expert consultations between clinicians and specialists from the Project ECHO hub also directly impact the health of patients, who benefit from the clinician’s increased knowledge of best practices.
  • Is Project ECHO cost-effective?

    Several studies have demonstrated the cost-effectiveness of this model, particularly in treating hepatitis C.5 Recent internal analyses by various Project ECHO hub partners have demonstrated cost-effectiveness generally and for chronic pain specifically.* These studies were conducted as part of a successful effort to convince state Medicaid officers and a state legislature to further expand their support for the project.

    *unpublished study

    Several Project ECHO hub partners are currently evaluating the cost-effectiveness and return on investment of the model, as well as its financial benefits in an accountable care organization setting.

  • Is the Project ECHO model also applicable in urban and suburban settings?

    While the ECHO model has typically been applied in rural settings, where the nearest academic medical center can be many hundreds of miles from a patient’s home, it has also been shown to be effective in urban and suburban settings where access to specialty care is limited. The University of Chicago, for example, is using the model to link clinicians in affiliated community health centers in Chicago and throughout Illinois with specialists. They are operating teleECHO clinics in risk-based approaches to women’s healthcare, hepatitis C, geriatric medicine, child and youth epilepsy, childhood obesity, pediatric ADHD and resistant hypertension.

  • How is patient confidentiality protected?

    Patient confidentiality is a pillar of the Project ECHO model. All of the patient cases presented in a teleECHO clinic session are de-identified. A HIPAA announcement is given prior to the start of each session to remind both hub specialists and spoke clinicians about the importance of preserving patient confidentiality. In addition, the teleconferencing system and other tools and resources used for teleECHO clinics must be HIPAA-compliant.

  1. 2

    Identify topic areas where there is a need for increased access to specialty care OR areas in which you are particularly interested in gaining deeper learning and specialization.

    Create a planning committee or team that will identify areas where there is a need for increased access to specialty care in your practice. The committee should include clinicians from various disciplines, as well as administrators who can work with your practice or organizational leaders to identify access shortage areas. It is very important that clinician special interests be included in this planning phase, as Project ECHO is a learner (clinician)-centric model rather than a patient-centric model. Once the planning committee has identified a particular clinical need or target area, you can connect to the ECHO Institute to find a hub partner in your topic area of interest and in your geographic region.

  • How often should my practice’s planning committee meet and what should we cover?

    The committee should plan to meet for approximately one hour a month for the first two to three months to review potential areas of need, plan who will participate in the teleECHO clinic sessions, discuss any existing data and respond to new opportunities or stresses within the clinic.

  • How do I make ECHO work if I have a smaller practice?

    If you have a solo or small practice, participating in one teleECHO clinic that is of interest to you personally may be a better option. This will allow you to gain knowledge and develop expertise in one area, and to test out and perfect your participation in the Project ECHO model. If you have a partner, he or she could choose a different topic area in order to further expand the services offered by your practice.

  1. 3

    Connect with Project ECHO hubs that offer training in your clinical area of interest.

    Project ECHO hubs offer virtual teleECHO clinics in specific areas of interest and in your geographic region. The hubs can answer questions and provide you with more information to help you decide if they fit your practice needs. The ECHO Institute at the University of New Mexico has a wealth of resources available to help you connect to hubs across the US and around the world. Hubs are located at more than 50 academic sites throughout the country (and around the world), and each offers teleECHO clinics in different specialty areas. Currently, there are more than 100 open clinics in hubs across the US.

  1. 4

    Join a teleECHO clinic session in your clinical area of interest to observe the format firsthand and learn from the didactic presentations.

  • How do I get no-cost CMEs by participating in teleECHO clinics?

    Participants who join a teleECHO clinic session receive CMEs for the total time spent participating, including time spent on didactics and patient case presentations. Each Project ECHO hub will have a clear process for providing CMEs as defined by their organization. All CMEs from participation in teleECHO clinics are given free of charge.

I think the idea of being part of a movement that’s going to reach a billion people is lofty.
I know there’s a huge need out there and just understanding that the current tools that we have
are not sufficient to meet the demand, the demand of expanding medical knowledge
and expanding need, is daunting. ECHO is probably the best idea to meet that demand.

—Dr. John Scott, University of Washington
  1. 5

    Present patient cases in a teleECHO clinic session.

    All teleECHO clinic sessions are case-based, so each will use a disease-specific or topic-specific case presentation template to assist you in structuring and presenting your complex patient case.

    Here are some brief instructional videos on how to (and how not to) present patient cases in a teleECHO clinic session.

    The Correct Way To Conduct An ECHO Patient Presentation

    Project ECHO: Sample Weekly TeleHealth HCV Clinic

    Dementia teleECHO™ clinic case presentation forms Download See all downloadable tools
    Endocrinology teleECHO™ clinic case presentation form Download See all downloadable tools
    Hepatitis C case presentation template Download See all downloadable tools
  • What issues or challenges have practices and clinicians faced in participating in teleECHO clinic sessions?

    Time constraints have been identified as one of the most significant challenges for practices and clinicians. The specialist teams, or “hubs,” often schedule teleECHO clinic sessions either before office hours or during lunch to avoid taking away from clinician-patient time. Participating in a teleECHO clinic session via videoconferencing requires broadband Internet access at every site, but this has not been a limiting factor for the practices currently participating in the project. Some clinicians may also participate from home or call into the teleECHO clinic session to listen to the case presentation.

  • How much time does it take to participate in a teleECHO clinic session?

    Most teleECHO clinic sessions are held for one to two hours per week depending on the clinical topic area and hub partner.

  • Who should participate in teleECHO clinics? Physicians and other health care professionals as individuals? Teams? Community health workers (CHWs)?

    Individual clinicians of all levels are welcome and highly encouraged to participate in teleECHO clinic sessions, including physicians, physician assistants, nurse practitioners, registered nurses, psychiatrists, social workers, community health workers and pharmacists. Team participation is encouraged, as team‑based care is the ideal model for enabling task shifting and higher-level care delivery.

  • How much does it cost to participate in a teleECHO clinic?

    Participation in a teleECHO clinic is usually free. The only associated costs are those for IT equipment (if needed) and time away from clinic. Most practices already possess the required IT equipment to connect via video (Internet and webcam), so no additional costs are incurred.

  • What IT equipment is required to participate in a teleECHO clinic session?

    The technology can be as simple as an individual using a landline phone, laptop or a handheld mobile device (smartphone); alternatively, a small room can be set up for one to two people or a videoconferencing room for larger groups. Project ECHO in New Mexico utilizes a cloud-based system called Zoom. This system has a number of benefits, including the ability to run on lower-speed Internet connections. Zoom works well on mobile devices such as smartphones and tablets, requires no applications, and has web-conferencing features like chat and sharing.

  1. 6

    Apply what you’ve learned to treat patients in your practice.

    After participating in several teleECHO clinic sessions, you will have the skills and knowledge to help many of your patients yourself or to discern when their conditions are so complex that they will need to be referred. Through your Project ECHO hub partner, you will have access to specialists in your region, which is helpful for triaging the most urgent and complex patients.

  1. 7

    Continue to participate in teleECHO clinic sessions to refine your skills, presenting patient cases as needed.

    Project ECHO is a self-paced learning model, where our target audience is comprised of primary care clinicians and multidisciplinary care teams in the community. Individuals participate in teleECHO clinic sessions on a regular basis, often for many months or years, especially in rapidly evolving, complex disease areas. Over time, participating community clinicians begin to receive referrals from other community clinicians, creating an effective triaging system in their region.

I enjoy ECHO immensely. I enjoy seeing all of the nurses and being able to talk to them all
and to find out problems or issues maybe with patients that they have not otherwise brought to our attention.
Now that we are doing ECHO, I don’t know how we did it without ECHO.

—Deborah Isaacs, Nurse Consultant for the New Mexico Department of Health

Conclusion

The Project ECHO model moves specialty knowledge into the community to help primary care clinicians care for patients with complex health conditions, expanding the care these patients are able to receive from the clinicians they know and trust. The interactive virtual learning platform, teleECHO, brings expertise to clinicians where they practice so they can grow their skill set and participate in a medical “brain trust” within the professional network of experts across the country and around the globe.

*All ECHO and UNM tools are furnished courtesy of ECHO Institute UNM Health Sciences Center which holds copyright.

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The project described was supported by Funding Opportunity Number CMS-1L1-15-002 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

References

  1. Arora S, Geppert CM, Kalishman S, et al. Academic health center management of chronic diseases through knowledge networks: Project ECHO. Acad Med. 2007;82(2):154-160. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855463/.
  2. Project ECHO: Spreading Access to Specialty Healthcare. http://www.youtube.com/watch?v=2lBfyOlL4_s. Accessed May 7, 2016.
  3. Project ECHO, Changing the World Fast. https://youtu.be/VAMaHP-tEwk. Accessed May 7, 2016.
  4. Bornstein D. The Power to Cure, Multiplied. New York Times. June 11, 2014. http://opinionator.blogs.nytimes.com/2014/06/11/the-doctor-will-stream-to-you-now/?_r=0. Accessed May 7, 2016.
  5. Wong JB, et al. Cost-effectiveness of hepatitis C treatment by primary care providers supported by the Extension for Community Healthcare Outcomes (ECHO) model. Presented at: 64th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2013; November 1-5, 2013; Washington, DC. Hepatology. 2013;58(Suppl S1):208A-1309A.
  6. Arora S, Kalishman S, Thronton K, et al. Expanding access to hepatitis C virus treatment—Extension for Community Healthcare Outcomes (ECHO) project: disruptive innovation in specialty care. Hepatology. 2010;52(3):1124-1133. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795614/.
  7. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364:2199-2207. http://www.nejm.org/doi/pdf/10.1056/NEJMoa1009370.
  8. Arora S, Kalishman S, Dion D, et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood). 2011;30(6):1176-1184. http://content.healthaffairs.org/cgi/pmidlookup?view=long&pmid=21596757.
  9. Bankhurst A, Arora S, Kalishman S, et al. Expanding access in rheumatology specialty care in New Mexico via an innovative community outreach program. Presented at: American College of Rheumatology/Association of Rheumatology Health Professionals Annual Scientific Meeting; November 9-14, 2012; Washington, D.C. Arthritis Rheum. 2012;64(Suppl10):2028. http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=789&id=102767#.
  10. Catic, A., Mattison MLP, Bakaev I, Morgan M, Monti SM, Lipsitz L. ECHO-AGE: A video-consultation program to bring geriatric expertise to long-term care. JAMDA. 2014;15:938-942. http://www.bidmc.org/~/media/Files/Centers%20and%20Departments/Medicine/Gerontology/ECHO/Catic%20ECHO-AGE%20JAMDA%202014.pdf.
  11. Catic AG, Mattison ML, Bakaev I, Morgan M, Monti SM, Lizsitz L. ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues. J Am Med Dir Assoc. 2014;15(12):938-942. http://www.jamda.com/article/S1525-8610(14)00547-7/abstract.
  12. Colleran, K et al. Building capacity to reduce disparities in diabetes: training community health workers using an integrated distance learning model. Diabetes Educ. 2012;38(3):386-396. http://tde.sagepub.com/content/38/3/386.long.
  13. Cordasco KM, Zuchowski J, Hamilton AB, Knapp H, Saavedra JO, Washington DL. VHA’s comprehensive women’s health SCAN-ECHO program: lessons learned. Presented at: 37th Annual Meeting of the Society of General Internal Medicine; April 23-26, 2014; San Diego, CA. J Gen Intern Med. 2014;29(Suppl 1):1–545. http://link.springer.com/article/10.1007/s11606-014-2834-9.
  14. Deming P, Anderson J, Dodd M, et al. Project ECHO: a novel model for clinical pharmacists in a multidisciplinary Telehealth care network for rural and underserved communities [abstract 224]. 2013 American College of Clinical Pharmacy Annual Meeting; October 13-16, 2013; Albuquerque, NM. Pharmacotherapy. 2013;33(10):e182-e299. https://www.accp.com/docs/meetings/abstracts/2013_annual.pdf.
  15. Davis R, Sauerwein T, Morrow C, Watson N, True M. Air Force Diabetes Center of Excellence Project ECHO: Successful telemedicine with a global reach. Presented at: American Diabetes Association 75th Scientific Sessions; June 5-9, 2015; Boston, MA; Abstract 779-P. Diabetes. 2015;64(Suppl 1):A187-A235. http://diabetes.diabetesjournals.org/content/64/Supplement_1/A187.full.pdf+html?sid=ba07d26e-d4f3-4703-a6cb-e8923b76a8ae.
  16. Dubin RE, Flannery J, Taenzer P, et al. ECHO Ontario Chronic Pain & Opioid Stewardship: Providing access and building capacity for primary care providers in underserviced, rural, and remote communities. Stud Health Technol Inform. 2015;209:15-22. http://ebooks.iospress.nl/publication/39206.
  17. Frank JW, Carey EP, Fagan KM, et al. Evaluation of a telementoring intervention for pain management in the Veterans Health Administration. Pain Med. 2015;16(6):1090-1100. http://painmedicine.oxfordjournals.org/content/16/6/1090.long.
  18. Gordon SE, Monti SM, Catic AG, et al. Project ECHO-AGE and Nursing Home Quality of Care. JAMDA. 2015;16(3):B27-B28. http://www.jamda.com/article/S1525-8610(15)00062-6/abstract.
  19. Harkins M, Raissy H, Moseley K, Luttecke K, Arora S. Project ECHO: Improving asthma care in New Mexico with telehealth technology. Presented at: CHEST 2011 Annual Meeting; October 22-26, 2011; Honolulu, HI. CHEST. 2011;140(R_Meeting_Abstracts):861A. http://journal.publications.chestnet.org/article.aspx?articleID=1045649.
  20. Ho M, Aron D, Sales AE, et al. The VA's specialty care transformational initiatives to improve access and delivery of specialty care. Presented at: 36th Annual Meeting of the Society of General Internal Medicine; April 24-27, 2013; Denver CO. J Gen Intern Med. 2013;28(Suppl 1):1-489. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654146/.
  21. Katzman JG, Comerci G, Duhigg D, Boyle JG, Olivas C. UNM ECHO-Pain and Headache Program. Presented at: 54th Annual Scientific Meeting of the American Headache Society; June 21-24, 2012; Los Angeles, CA. Headache. 2012;52(5):862-914. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2012.02174.x/epdf.
  22. Katzman JG. Making connections: using telehealth to improve the diagnosis and treatment of complex regional pain syndrome, an underrecognized neuroinflammatory disorder. J Neuroimmune Pharmacol. 2013;8(3):489-493. http://link.springer.com/article/10.1007%2Fs11481-012-9408-6.
  23. Katzman JG, Comerci G Jr., Boyle JF, et al. Innovative telementoring for pain management: project ECHO pain. J Contin Educ Health Prof. 2014;34(1):68-75.
  24. Kauth MR, Shipherd JC, Lindsay JA, Kirsh S, Knapp H, Matza L. Teleconsultation and training of VHA providers on transgender care: implementation of a multisite hub system. Telemed J E Health. 2015;21(12):1012-1018. http://online.liebertpub.com/doi/10.1089/tmj.2015.0010.
  25. Khatri K, Haddad M, Anderson D. Project ECHO: replicating a novel model to enhance access to hepatitis C care in a community health center. J Health Care Poor Underserved. 2013;24(2):850-858. http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v024/24.2.khatri.html.
  26. Knoefel J, Herman C. Dementia care training for primary care providers: Project ECHO™. Presented at: American Academy of Neurology Meeting; April 15-18, 2015; Washington DC; P6.182. Neurology. 2015;84(14 Supplement). https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/7.Conferences/1.CONFERENCES/1.Annual_Meeting/15AM%20AbstractListing.pdf.
  27. Mitruka K, Thornton K, Cusick S, et al. Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model: Arizona and Utah, 2012–2014. MMWR Morb Mortal Wkly Rep. 2014;63(18):393-398. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6318a2.htm.
  28. Moore A, Manch RA. Synchronous cohorts: a novel variation to the Project ECHO approach to hepatitis C treatment. Presented at: 64th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2013; November 1-5, 2013; Washington, DC. Hepatology. 2013;58(Suppl S1):208A-1309A. http://liverlearning.aasld.org/aasld/2013/thelivermeeting/36991/ann.moore.synchronous.cohorts.a.novel.variation.to.the.project.echo.approach.html?f=m2t1358.
  29. Salgia RJ, Mullan PB, McCurdy H, Sales A, Moseley RH, Su GL. The educational impact of the Specialty Care Access Network–Extension of Community Healthcare Outcomes Program. Telemed J E Health. 2014;20(11):1004-1008. http://online.liebertpub.com/doi/abs/10.1089/tmj.2013.0302.
  30. Scott JD, Unruh KT, Catlin MC, et al. Project ECHO: a model for complex, chronic care in the Pacific Northwest region of the United States. J Telemed Telecare. 2012;18(8):481-484. http://jtt.sagepub.com/content/18/8/481.long.
  31. Socolovsky C, Masi C, Hamlish T, et al. Evaluating the role of key learning theories in ECHO: a telehealth educational program for primary care providers. Prog Community Health Partnersh. 2013;7(4):361-368. http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/progress_in_community_health_partnerships_research_education_and_action/v007/7.4.socolovsky.html.
  32. Su GL, et al. Implementation of the first Department of Veterans Affairs Specialty Care Access Network-Extension of Community Healthcare Outcomes (SCAN-ECHO) program for chronic liver disease. Presented at: 63rd Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2012; November 9-13, 2012; Boston, MA. Hepatology. 2012;56(Suppl S1):191A-1144A. http://onlinelibrary.wiley.com/doi/10.1002/hep.26040/abstract.
  33. Watts SA, Roush L, Julius M, Sood Al. Improved glycemic control in veterans with poorly controlled diabetes mellitus using a Specialty Care Access Network-Extension for Community Healthcare Outcomes model at primary care clinics. J Telemed Telecare. 2015 Aug 6 [epub ahead of print]. http://jtt.sagepub.com/content/early/2015/08/04/1357633X15598052.long.
  34. Wong JB, et al. Cost-effectiveness of hepatitis C treatment by primary care providers supported by the Extension for Community Healthcare Outcomes (ECHO) model. Presented at: the 64th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2013; November 1-5, 2013; Washington, DC. Hepatology. 2013;58(Suppl S1):208A-1309A. http://onlinelibrary.wiley.com/doi/10.1002/hep.26727/abstract.

STEPS in practice

Case 1

How’s it working in Brownsville, TX?

Dr. Rose Gowen is an obstetrician/gynecologist and the Medical Director at the Su Clinica clinic in Brownsville, Texas. She was one of the first participants in the MD Anderson ECHO for Cervical Cancer Prevention.

Dr. Gowen felt a desire to learn more about the loop electrosurgical excision procedure (LEEP) and to gain more training in colposcopy for her patients who have abnormal Pap smear results. Week after week, she would see women in the clinic who had abnormal Pap smears and she felt restricted because she simply did not have the tools or resources to provide follow-up care. Instead, she was faced with referring patients to a specialist at a clinic approximately one hour away from Brownsville and who was available only once per month to provide follow-up care. Many patients were unable to make the trip, did not have transportation or did not have the financial means to be able to visit the clinic; those who did often had to wait weeks to obtain an appointment.

Feeling frustrated, Dr. Gowen began looking for LEEP training online and in her own community but could not identify any training that would help her learn the hands-on techniques required to feel comfortable performing LEEP in her own clinic. She began first by searching for training opportunities online but found few that seemed applicable for an experienced physician. Next, Dr. Gowen approached several physicians in and around the Brownsville community to inquire about potential opportunities to shadow those experienced in this area. Despite several attempts, no one would offer to assist her in her desire to obtain additional training.

That’s when she met Dr. Schmeler from MD Anderson Cancer Center in a chance public health meeting in Houston. During the meeting, both Dr. Gowen and Dr. Schmeler commented on the need for additional access to cancer prevention care in remote rural communities. Immediately, Dr. Schmeler and Dr. Ellen Baker, who leads the MD Anderson ECHO for Cervical Cancer Prevention, offered to help. They traveled from Houston to Brownsville to offer hands-on training in LEEP, and assist with purchasing colposcopy equipment to increase local access to colposcopies within Brownsville and Harlingen. Now, armed with the knowledge and the equipment, Dr. Gowen, a nurse practitioner, and a nurse midwife can provide LEEP and colposcopy care for their patients. Patients no longer have to travel long distances for the monthly clinic and those patients with limited resources can have more peace of mind knowing that their abnormal Pap smear results can be followed up locally.

Dr. Gowen and her colleagues at the clinics in Brownsville and Harlingen now participate in the weekly MD Anderson teleECHO clinic sessions, which were started right after the hands-on LEEP training was provided. Participation in the MD Anderson ECHO for Cervical Cancer Prevention has led to an increase in the number of women obtaining preventive care Pap smears in the clinic and a decrease in the number of women who are referred to cone biopsy. Instead of waiting weeks and sometimes even months to get care, these women are able to undergo follow-up procedures in their own communities.

Additionally, physicians and other health care professionals in the clinic feel greater professional satisfaction knowing that they can provide the care for their patients and that they have the opportunity to connect with experts in an area that they feel very passionate about. Participants earn CME credits, which is also a tremendous benefit because the training is free and they can immediately relate what they have learned to actual patient care. The MD Anderson ECHO for Cervical Cancer Prevention has also been very helpful in increasing clinicians’ adherence to recent changes in clinical guidelines. Clinicians previously might have been more resistant to making a change, but with the help of the Project ECHO experts, they recognize how the changes in guidelines and clinical recommendations improve care for their patients on a firsthand basis.

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Case 2

How’s it working in Columbia, MO?

Dr. Bernie Eskridge is a pediatrician at the University of Missouri in Columbia, Missouri who is engaged in the Missouri ECHO for Autism. The goal of their teleECHO clinic is to increase confidence in identifying and treating autism symptoms and to expand knowledge about behavioral treatments for autism. As participants in the teleECHO clinic, PCPs and other health care professionals have access to experts from the Thompson Center for Autism and Neurodevelopmental Disorders. These experts help clinicians increase their own knowledge about evidence-based practices for screening, diagnosis and treatment of autism; common medical and psychiatric concerns in children with autism; and successful office visits for children with autism and other behavioral concerns.

Dr. Eskridge first joined Missouri ECHO for Autism out of a desire to learn how he could help his patients while they were waiting the 6 to 18 months it takes to confirm an autism diagnosis. He felt a great need to learn more about tools and techniques to address his young patients’ comorbid conditions and ease some of the symptoms that parents were reporting during the diagnostic waiting period.

He participates in the virtual 90-minute teleECHO clinic sessions every first and third Wednesday of each month, during which time he is able to discuss very complex cases and receive real-time advice from the hub experts. The experts provide recommendations about how to treat patients’ immediate needs and understand what is best to say to parents as they are waiting for diagnostic confirmation. Additionally, he has learned much more about local resources he can offer patients who are looking to jumpstart treatment for their children. Those patients who are at critical stages in their care can also often be seen much more quickly as a result of the professional networks and relationships that Dr. Eskridge has built with experts through regular participation in the teleECHO clinic sessions.

Dr. Eskridge feels that participating in teleECHO clinics is more than worth the time spent, particularly if clinicians are interested in a particular disease or condition. He recommends that all clinicians consider blocking their time to attend a teleECHO clinic session because it provides an invaluable opportunity to learn from the experts, gain CME credits and gain confidence in providing care in areas that may feel less familiar or for which no formal training was received.

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Case 3

How’s it working in Las Vegas, NM?

Chris Ruge is a nurse practitioner working in Las Vegas, New Mexico. He first learned of Project ECHO when he was doing phone and e-mail interviews with El Centro from Mexico for several weeks in the Spring of 2008. Intrigued by an initial visit to the Project ECHO website, Chris visited the Albuquerque offices of the ECHO Institute to observe firsthand the HCV teleECHO clinic and was impressed by the professionalism, the relaxed and welcoming atmosphere, and the effectiveness of the clinics. Eight years later, Chris has never been disappointed while working and collaborating with the project.

In his practice, Chris uses Project ECHO as a means of establishing both a working and personal relationship with the specialist hub in Albuquerque. The HCV teleECHO clinic sessions provide him with nearly unlimited access to the HCV specialists with whom he can discuss urgent issues in the care of his patients. Without this support and structure, his work with complicated patients with numerous chronic illnesses would be much more difficult, likely necessitating numerous referrals to specialists located 60‑100 miles away—too far for his patients with very limited resources. Additionally, participation in the HCV teleECHO clinic sessions have made it possible for him to treat patients with HCV and HIV who he would not have otherwise felt safe or competent treating on his own.

The clinic where Chris works has several clinicians who are each engaged in different teleECHO clinics. By participating in Project ECHO, all of the clinicians feel connected, not only to other peers facing similar struggles with their own patients but also to clinicians in other rural areas. As Chris explained, the ECHO clinic helps him to feel less isolated while living and working in a town of 14,000 people 60 miles from the nearest “big city” of Santa Fe.

For Chris and his colleagues in Las Vegas, working with Project ECHO allows rural primary care clinicians to both provide more evidence-based primary care and to participate in more focused and specialized care such as the treatment of patients with HCV or with poorly controlled psychological conditions or endocrine-related issues. He and his colleagues feel that they are continuously learning from the collaborations with the specialists in the Project ECHO hub, helping them to grow as clinicians while receiving some 80-100 CME credits annually.

For patients, the participation of their primary care clinicians in teleECHO clinics make it possible to receive excellent primary care in their home community while having their particular health issues examined closely by some of the most knowledgeable specialists in the state. Patients save the time and expense of travelling all day for a fifteen-minute visit with a specialist who may know very little about them and will likely not circle back to connect with the referring clinician. Patients can have more confidence that their PCP or other health care professional knows what is going on with them and that they are meeting with specialists who are helping to guide their medical decisions.

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Case 4

How’s it working in Jordan Valley, MO?

Dr. Thomas “Pete” Pirotte in Jordan Valley, Missouri first learned about the Project ECHO model in February 2015 when the federally qualified health center (FQHC) administrator, who is also a physician, suggested that he join the Chronic Pain Management ECHO in Missouri and provided him support to join. Dr. Pirotte found that the evidence-based practice guidelines provided through Project ECHO are indispensable. He had looked for some of the information discussed in the teleECHO clinic sessions, but could not easily find it in the literature. Participating in the teleECHO clinic sessions also offered him valuable perspectives from participating colleagues.

Within his clinic, Dr. Pirotte has become the go-to doc for questions about opiates and regularly shares new and valuable information from the Chronic Pain Management teleECHO clinic with his colleagues.

When asked about the value of ECHO, he responded, “It is no question we are practicing safer, better medical care. I feel more empowered to educate patients and families. About six weeks ago we had a clinic-wide conference on benzodiazepines and opioids that was based on the information provided in a previous ECHO.” He also stated that participation in the Chronic Pain Management ECHO may have helped to prevent a death or two and has definitely reduced emergency room (ER) visits and hospitalizations. Fewer and fewer patients are experiencing bad outcomes.

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Case 5

How’s it working in Billings, MT?

Dr. Eric Arzubi uses the Project ECHO model for a pilot project of an addictions/behavioral health ECHO, which is one component in a larger collaborative effort with the State of Montana’s Department of Corrections, the Rimrock Foundation (a local addiction services clinic) and the Billings Clinic. The project is funded through a grant from the Montana Mental Health Trust.

Dr. Arzubi, reflecting on what prompted him to start using Project ECHO, says “common sense.” Montana faces many challenges that are very similar to those of New Mexico and other communities that have implemented this model. Montana is at the epicenter of a mental health crisis, posting the highest suicide rate in the U.S. There are many remote, rural populations with highly vulnerable citizens, including many veterans and Native Americans. Additionally, Montana is one of only three states that does not host a psychiatry residency program; thus, the shortage of clinicians is especially acute.

Introducing the Project ECHO model, which includes clinicians from prisons, jails and pre-release centers in Montana, has sparked conversations that may not have been possible six months prior. Thanks to the pilot of the addictions/behavioral health ECHO, Dr. Arzubi and his colleagues are actively engaged in identifying systems gaps for the incarcerated population with mental health problems. Without the Project ECHO model, Dr. Arzubi reflects, the clinicians would not be engaging in regular, consistent collaboration with the State of Montana Department of Corrections. Additionally, Montana’s SIM Council is now working on implementing the model to help integrate primary care and behavioral health on a much larger scale.

When asked about the barriers to implementation, Dr. Arzubi comments that the customer service delivered by the ECHO Institute at the University of New Mexico is outstanding and makes rollout very user friendly. For him, the most important ingredient for introducing and sustaining Project ECHO participation has been a set of champions among the stakeholders and some seed money to help fund the project initially.

To date, Dr. Arzubi and his colleagues have completed three teleECHO clinic sessions. After the first session, the State of Montana Department of Public Health and Human Services began focusing on Project ECHO to learn about the model and how it might fill gaps in the mental health system of care. The Montana addictions/behavioral health ECHO has promoted dialogue, facilitating the development of a common language between two diverse systems (corrections and health care), and inspiring stakeholders to think differently about the State’s healthcare challenges.

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Downloadable tools

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The tools and resources here can offer implementation support for your practice. You can download and modify them to fit your specific needs.

Complete Project ECHO toolkit

Access all the tools and resources in the toolkit.

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(ZIP, 7,106 KB)

Module Completion

Individual tools

  • Project ECHO module

    Download a printable PDF version of this module.

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    PDF, 574 KB

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  • Project ECHO PowerPoint

    Use this PowerPoint presentation to review this module with your team.

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    PPT, 3,125 KB

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  • Sample budget template

    This is a sample budget template for building an ECHO clinic.

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    MS EXCEL, 230 KB

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  • 2016 teleECHO™ clinic welcome packet

    This is a welcome packet for new members of a teleECHO™ clinic.

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    MS WORD, 68 KB

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  • Dementia teleECHO™ clinic case presentation form

    This is the case presentation form for patients with dementia.

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    PDF, 460 KB

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  • Endocrinology teleECHO™ clinic case presentation form

    This is the case presentation form for patients with endocrine issues.

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    PDF, 969 KB

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  • ECHO planning worksheets

    These forms will assist in describing the cases you will be presenting and the necessary resources involved.

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    PDF, 533 KB

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  • ECHO Replication Partners by Focus Area

    This is a description of all of the ECHO partners and their focus areas.

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    MS WORD, 60 KB

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  • Hepatitis C case presentation template

    This is the case presentation template for patients with Hepatitis C.

    Download

    PDF, 420 KB

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  • US ECHO partner map

    This map shows the location of all of the ECHO clinics in the United States.

    Download

    PDF, 447 KB

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  • Project ECHO value proposition

    This document shows the value proposition for the ECHO model.

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    PDF, 859 KB

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