Why Sharing May Be The Fastest Way To Transform Rural Health Care
n good news for rural health care in the U.S., President Obama signed the Expanding Capacity for Health Outcomes (ECHO) Act into law last month after it passed unanimously in the Senate.
We caught up with Ashoka Fellow and Project ECHO founder Sanjeev Arora in Albuquerque, New Mexico, to hear about the policy win, what it means, and why sharing knowledge for free may be the fastest way to spread your idea.
Ashoka: First, some grounding: is ECHO is the same as telemedicine?
Dr. Sanjeev Arora: No, but it’s a fair question. In telemedicine, doctors treat patients via video conference – one on one as they would in a clinic setting. This means they are seeing a patient in one part of the world and not seeing a patient locally. Project ECHO also uses video conferencing but our goal is different. We connect specialists with groups of primary care doctors to demonopolize the specialist’s knowledge and infuse it into the system. This benefits 10x the number of patients, making ECHO a force multiplier and how we expand access to care.
Ashoka: Interesting – and you came at this idea as a specialist?
Arora: Yes, hepatitis C is my specialty and when I came to New Mexico, a rural state, I saw right away the challenge of reaching “last-mile”
patients who live hundreds of miles from population centers and medical centers. The question became: how do we get the right knowledge to the right place at the right time so that patients get the care they need without needing to travel? That was our starting point.
Ashoka: And, practically, how did you start?
Arora: We piloted Project ECHO at the University of New Mexico Health Sciences Center in 2003 with what I knew best – hepatitis C – and it was successful. So we extended the programs in New Mexico to over 20 different complex conditions, and that worked. Then we decided to teach other universities how to implement the ECHO model. There are now over 60 ECHO partners (hubs) in the U.S. reaching many thousands and thousands of clinics in 55 different disease areas and conditions. We also have pilots in over 20 countries on six continents. Across the network, we share resources, curricula, lectures, evaluation tools, presentation templates, everything. We bring the ECHO systems, including processes and software, so that information can be stored efficiently and rapidly shared among collaborators and in both directions. A key principle of ECHO is that everyone is a teacher and a learner. Primary care physicians spot things that specialists may miss and can see things from a different point of view.