Patients in rural and underserved areas may soon receive specialized care from their family doctors, thanks to the growth of Project ECHO.
Oklahoma State University has developed an iHealth team to spread the Extension for Community Healthcare Outcomes model, and the Expanding Capacity for Health Outcomes Act has been passed by both the U.S. Senate and House of Representatives within the past two weeks.
Project ECHO began with Dr. Sanjeev Arora in New Mexico as a way for his clinic to educate primary care clinicians on how to treat hepatitis C in their communities. Community doctors, clinicians, nurse practitioners, social workers, and other health care providers can now use teleconferencing to gain knowledge and find treatment solutions from specialists.
"Project ECHO is a new way to deliver specialized health care," said Dr. Jason Beaman, psychiatrist, family medicine physician, and assistant clinical professor at OSU. "The slogan for Project ECHO is 'Moving knowledge, not patients.' We want the knowledge to travel, but the patient to stay in their hometown, and be treated by their hometown physicians."
Beaman is part of a team that has been training at the University of New Mexico for the past year to offer Project ECHO. Although the project covers close to 100 specialities, OSU just began psychiatry videoconferences two months ago, and plans to implement four other fields next year: addiction, family planning, HIV, and obesity.
The once-a-week video conferences, called teleECHO clinics, are open to health care providers who want to treat local patients without sending them to specialists.
"The first step is getting the physicians to realize they don't have to refer; referral is a huge safety net for a physician, and a lot of that is they don't know what they don't know and they want it treated by the specialist. As a specialist, I think that family medical physicians are very confident to treat a wide array of illnesses and conditions," said Beaman. "I recognize that a lot of them are far removed from training and maybe didn't have a lot of training in mental health, and that's OK; that's what I'm here for. We're never going to let them do anything that would ever harm the patient. All of our recommendations are evidence-based and within the guidelines."
Beaman said the weekly sessions are like a two-hour training.
"It's not just a consult, it's a conference. It starts with a 15-minute lecture. The next hour and 45 minutes is spent going over cases, so the family medicine doctor gets to hear not only how I would treat his patient, but how we would treat everyone else's patients," said Beaman. "What we find is that after a year, they don't need to consult with me any more and we have a pretty good psychiatrically-trained family medicine physician in Tahlequah who doesn't need to refer."
Cherokee Nation Health Services has been working with UNM to combat hepatitis C.
"We are using Project ECHO to increase the number of medical providers who can evaluate and treat the hepatitis C virus," said Jorge Mera, director of Infectious Diseases for Cherokee Nation Health Service. "Increasing clinical capacity is essential for an elimination program."
Patients in rural communities often spend a lot of time and money traveling to specialist in larger cities. They may also have to wait weeks or months to even see a specialist.
Project ECHO is free to health care providers. All that is needed is a device capable of videoconferencing, the internet or data package, and to register for and attend the teleECHO clinic.
Beaman's clinic begins at noon so the participants can use their lunch hour.
"The physicians are, now more than ever, under time constraints, but it's two hours a week, and one of those hours is over lunch, and we do that intentionally. I bring my lunch, I want them to bring their lunch, so it really only costs them an hour, and they're able to provide so much more service to their patients," said Beaman. "It's an hour of their time, but it's hours and hours of their patients' time they spend traveling or waiting, or their condition is going untreated or suboptimally-treated while they're waiting on the referral."
Currently, no one from Cherokee County is participating in the teleconferences, but all are invited to look into the program and register for a session.
Sessions are happening around the globe, as the medical profession and governments are recognizing the power of Project ECHO. Doctors can treat multiple patients with the information they gain from the weekly conferences.
"The care we are providing with my team is evidence-based, algorithm-driven. It's the most up-to-date psychiatric treatment," said Beaman. "What we're telling your physician is the edge of medicine, academic medical excellence."