Project ECHO: The Future of Medicine?

Do you ever have a quick question about a patient?  Sometimes, I find myself looking through lab results or analyzing an EKG when a small change in the patient's results catches my eye.  Is this finding significant, or inconsequential?  If it is significant, how urgently does the issue need to be addressed?  Often, I think I know the answer to a question but want reassurance to be more confident in my decision making.

In my case, I work in the emergency department with an awesome group of nurse practitioners, physician assistants and physicians who are happy to offer reassurance to one another and help when questions arise.  We find ourselves collaborating, discussing various lab findings, X-Ray readings, or simply sharing interesting cases.  But, some medical providers don't enjoy this luxury.

Many NP's, PA's and physicians, especially those working in rural or underserved areas, have little recourse when questions arise.  Their patients may not have access to certain types of specialists leaving them as the sole medical provider not only for primary care problems but also for diagnoses that usually warrant specialist referral.  Providers working alone don't enjoy the luxury of asking quick questions of other coworkers- a question often means referring the patient to a specialist if possible costing money and time.  

Fortunately, the world of medicine is changing and beginning to embrace technology and team-work.  Though in many circles telemedicine has reached resistance, doctors in New Mexico have successfully implemented telemedicine as a means for asking advice from specialists for years.  Project ECHO (Extension for Community Healthcare Outcomes) allows primary care providers in rural and underserved areas of New Mexico to access specialist knowledge.  Providers can discuss complex cases with other PCPs and well as with specialist providers in a weekly videoconference.  Though the idea it simple, the project is brilliant and patients in New Mexico's underserved areas are reaping the benefits of Project ECHO's ingenuity.  

Project ECHO was initially developed by University of New Mexico's Dr. Sanjeev Arora, a liver disease specialist, as a way to expand access to better treatment for hepatitis C.  Since it's launch in 2003, the project has grown to include other conditions like chronic pain, high-risk pregnancy, diabetes and nephrology.  

Creators of Project ECHO recognize that medical practice is not keeping up with advances in medical knowledge and hope easy access to specialists can reverse this trend.  Currently, Americans receive appropriate, evidence-based care just 55% of the time.  An estimated 80,000 Americans die each year because they do not receive proper care for chronic conditions.  Access to specialized knowledge and the support of a team through videoconferencing helps primary care providers get their questions answered.  Discussing complex patients with specialists helps PCP's expand their skills and continue learning throughout their careers.  

Project ECHO's results prove the system works.  Primary care physicians participating in Project ECHO now have cure rates for Hepatitis C that rival those of university-based specialists.  Racial and ethnic disparities in outcomes for patients with hepatitis C in Project ECHO clinics have significantly improved.  The system saves patients the cost and hassle of specialty referrals which may not be available in many areas.  Not only does Project ECHO benefit patients, providers report that participation in the program has increased their knowledge, self-efficacy and professional satisfaction

Imagine how your practice would change if you could have weekly access to an endocrinologist, a hepatologist, a psychiatrist and a clinical pharmacist.  Think about how much you would benefit by spending an hour each week learning from other highly specialized providers.  Working with such a team helps providers feel more confident and competent in their practice and improves patient outcomes.  More states should adopt and promote Project ECHO type forums to support primary care providers.