The Project Extension for Community Healthcare Outcomes (ECHO) was started at the University of New Mexico School of Medicine, after several noticed extraordinarily long waits for hepatitis C care in New Mexico. The effort has resulted in an international effect, with more than ninety hubs participating in the effort, offering subspecialist guidance to primary care physicians, nurses, and other clinicians across the United States and in twelve other countries.
The hub-and-spoke model used in ECHO had previously been used to transform the field of aviation, and is now being applied to the continuing education of primary care physicians with the aim of enabling access to hard-to-find specialty care in remote areas. Here, the “hub” is the team of academic subspecialty experts who work to make themselves available to primary care physicians – the “spokes” – through web-enabled videoconferencing sessions. The videoconference sessions cover dozens of conditions such as chronic pain, HIV, hepatitis C, endocrinology, dementia, autism, addiction, and diabetes.
The videoconferencing sessions last 90 minutes, are available for free, and are eligible for continuing medical education (CME) credits. They are organized by disease or topic, and feature presentations that are made by physicians seeking guidance. The doctors are provided various examples and templates on how to present case information so that the subspecialty experts have the information they need to offer meaningful advice.
ECHO goes beyond typical CME offerings by providing primary care physicians with a way to present their most complex cases to expert teams and to learn by managing their own patients with interactive guidance from subspecialists.
AMA STEPS Forward Module
An AMA STEPS Forward module outlines seven things physicians can do to integrate the program into their practices. The first thing is to learn more about the ECHO model, which can be done by watching a TEDx talk by Sanjeev Arora, MD, the project director, “Changing the World, Fast.” The second thing is to identify topic areas where there is a need for increased access to specialty care or areas in which the physician is particularly interested in gaining a deeper learning or specialization. If it is a larger practice that is interested in engaging in the program, it is suggested that a multidisciplinary planning committee should meet for roughly one hour a month for two to three months to help determine educational needs.
Third, physicians should connect with Project ECHO hubs that offer training in the clinical area of their interest. Fourth, physicians should join a Project ECHO session in their clinical area of interest to observe the format firsthand and learn from the didactic presentations, for which participants get CME credits for the total time spent on the activity.
Fifth, it is suggested that physicians present patient cases in a Project ECHO clinic session, which happen roughly once a week. Physicians are not the only health professionals permitted to take part, nurse practitioners, psychiatrists, social workers, and pharmacists are also encouraged to step in and participate. From there, after a few sessions, participants are encouraged to apply what has been learned to treat patients in practice.
Lastly, participants are encouraged to continue participating in Project ECHO clinic sessions to refine skills and present patient cases as needed. Given that it is a self-paced learning model, some physicians may learn what they need about a particular topic in just a few sessions and quickly move to another topic of interest, while others who are passionate about a clinical topic may opt to attend sessions in that area for years, becoming experts and receiving referrals through Project ECHO.