Telehealth and virtual medicine received a big boost when President Obama signed into law the Expanding Capacity for Health Outcomes (ECHO) Act in December 2016.
Project ECHO was a model tested by the University of New Mexico (UNM) to measure the effectiveness of linking academic specialists with primary care clinicians in local communities. The model aims to dramatically increase access to specialty treatments in rural and underserved areas for patients suffering from complex conditions. These include, but are not limited to, hepatitis C, HIV, chronic pain, and behavioral health disorders.
The networks are virtual – users dub them “teleECHO” clinics – and they have proven so effective in New Mexico that the bipartisan ECHO Act (S. 2873) was drafted and passed. The bill’s purpose is “to require studies and reports examining the use of… technology-enabled collaborative learning and capacity building models to improve programs of the Department of Health and Human Services, and for other purposes.”
The number of programs have grown in recent years, including clinics developed by the New York State Health Foundation, GE Foundation, Greater Rochester Health Foundation, Health Foundation for Western and Central New York, Robert Wood Johnson Foundation and the Leona M. and Harry B. Helmsley Charitable Trust (Health Affairs Blog, Jan. 24, 2017).
The ECHO clinics make use of telehealth applications like videoconferencing and remote patient monitoring and connect academic specialists with primary care physicians as part of weekly conferences. There, mentoring and patient case presentations are conducted, with care for complex conditions overseen by experts.
A study published in a June 2011 issue of the New England Journal of Medicine concluded patients diagnosed with hepatitis C were more likely to receive sustained, effective treatment through the New Mexico ECHO model than through the UNM clinic. Serious adverse events were more likely to occur at a higher rate of patients at the clinic compared to those serviced through the ECHO virtual site.
The concept is not without its detractors, some of whom are worried about how well primary care physicians can be taught by the specialists, since the personnel and disease states being addressed will differ on a site-by-site basis. There’s also the question of how to maintain costs of the program and how to ensure providers are properly reimbursed, particularly as the healthcare industry continues to move away from fee-for-service and toward a more value-based system.
The model has its champions as well, as evident by the well-established medical foundations and bipartisan lawmakers who have embraced it and advocated for expansion. UNM estimates there are now more than 50 sites in the U.S., including the participation of 100 global partners from more than 20 countries. As telemedicine applications continue to grow and become more widely-adopted, expect to see an increase in the number of rural patients utilizing these telementoring clinics.
Chris Silva is an analyst at DRG and specializes in information technology, telehealth and big data, among other topics. Follow him on Twitter at @ChrisSilvaDRG