Jun 16, 2014

Dr. Kim: Project ECHO, an innovative and powerful way to empower providers throughout our community. This is Robin Kim for The Scope.

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Dr. Kim: We're here with Dr. Terry Box, the Medical Director of Transplantation, the Chief Hepatologist at the University of Utah. Tell us about Project ECHO.

Dr. Box: Thank you, Robin. It's my pleasure to talk about Project ECHO. I've been doing that a lot since 2011. It is indeed very innovative, disruptive in that it has disrupted the way we think about delivering education, quite frankly. Project ECHO was created by a colleague of mine at the University of New Mexico. Geographically, Utah and New Mexico share a lot. Specifically, in the area of delivering care for diseases that are common yet complex into rural and underserved areas was the motivating factor for Dr. Arora to come up with his concept of Project ECHO.
ECHO, by the way, is a not a cardiology term. It is an acronym that stands for Extension for Community Healthcare Outcome, and that's exactly what Dr. Arora was able to do. No longer is his liver clinic at the University of New Mexico filled with patients with hepatitis C who have to travel literally hundreds of miles round trip to see him for a 20-minute office visit. Now they can be seen, evaluated, effectively managed, treated in their community by their doctor in their home, with whom they have great confidence. And as result, the outcomes are exactly what they would be elsewhere, and they do it for less money and in a much more convenient way.

Dr. Kim: As a transplant doctor and as an educator, how are you using Project ECHO to further your mission here at the University of Utah?

Dr. Box: The primary mission of Project ECHO is education. This use of technology can be used to create areas of knowledge, of little mini-experts in any community, any scenario where an interested provider has a group of patients that need to be treated. After we learned how effective this could be in managing a very complex disease treatment like hepatitis C, we also began to see its utility in providing followup for all of our patients who have had solid organ transplant who themselves must frequently drive hundreds of miles each way to come see not only us in liver but our colleagues in the other solid organ areas. So we are educating our colleagues in the more remote areas who have patients in their community who are post transplant to be effective with our immediate and 24/7 supervision.

Dr. Kim: Give us a rundown of exactly how liver care ECHO, for example, is run. Describe for us the room, the interactions, the people involved.

Dr. Box: If you are old enough to remember the Hollywood Squares, you will have a distinct image of what is portrayed on the monitor every time we have a clinic. Each provider on his or her laptop, desktop, even phone should they have the software will be able to dial into our clinic. Projected on the monitor are a multitude of squares much like a tic-tac-toe board with a face of each provider who's calling in from literally seven states in the Mountain West.
Everybody who has a patient about whom they want to speak that day will make a short case presentation. Either I or my colleagues around the table will offer advice. Frequently there's a wonderful interchange of thoughts and ideas. That's exactly how we learn in medicine. This is case-based learning. Frequently we will discuss anywhere from half a dozen to 10 new and challenging cases. Each one is discussed by the mentor or mentors, should there be enough, and everybody learns from every case.

Dr. Kim: Do you have a particular topic in mind? Do you have even lectures or didactics that you interlace within the case-based learning?

Dr. Box: We do frequently do little short didactics just to bring everybody up to speed on the latest and greatest, so to speak. Or when I perceive a need among the providers from previous clinics that we need to review a topic, we will do that in a short didactic, which is frequently given with some PowerPoint slides for five, 10 minutes. If there are a dozen cases we need to get through, I think the learning is always better when you have that real-time patient that you know you're going to talk about and maybe immediately walk out that door and take care of. That's when learning occurs in its most efficacious way.

Dr. Kim: Project ECHO, one of its greatest powers is the ability to bridge distances. And so give me an example of some of the geographic areas that you'll serve through Project ECHO.

Dr. Box: Well, interestingly, we can serve anywhere the Internet can go, and on some days, one feels that that's exactly what's happening. We have providers from Kalispell, Montana, down to southern Utah, over to northern and southern California, and as far east as Cheyenne, Wyoming, and all points in between. We cover Utah as well as six adjacent and not so adjacent states.

Dr. Kim: One of the hot topics in health care is the ability to deliver excellent care or to empower other providers to deliver excellent care in an economic way. How does Project ECHO achieve that?

Dr. Box: Since this is a group of specialists mentoring primary providers of all ilks-PAs, NPs, docs-we use case-based, evidence-based medicine whenever we can. In so doing, we think we are delivering the best possible education. In so doing, we think the providers on the other end, who then take this information and treat patients, are treating in the best possible way. We are doing this from our offices here at the University of Utah, talking to a dozen providers in six or seven states. Clinic will last an hour to an hour and a half.
We have more or less provided education over a thousand-mile radius around Salt Lake City to multiple providers without leaving our offices. We have created efficiency. We have created a so-called knowledge network. We have leveraged the resources of the specialists at the University of Utah Medical School to help whoever can join us for an hour to an hour and a half every week.

Dr. Kim: I'd like to join right now. What's the best way that we can as providers outside in the community get access to the liver care ECHO and Project ECHO?

Dr. Box: Well, there's not much one has to do, but you do have to have the appropriate software so that you can join us on our HIPAA-compliant telehealth network. To obtain that software, which is free, by the way, one can contact us at Project ECHO at the University of Utah.

Dr. Kim: Where can Project ECHO go?

Dr. Box: There are 20 different disciplines across all aspects of medicine. So we have rollouts planned for different disease states, diabetes care being one, chronic pain management being another. High-risk OB has been considered. Adult psychiatry. Wherever there is a demand, wherever there is a champion on the other end to become that mini-expert, we can find providers here to do the mentoring. We just need the champions. We need the interest. We need the access. We need the support.

Dr. Kim: Dr. Box, thank you for giving us a report on this very powerful and innovative way to deliver care through Project ECHO. We hope that our listeners will take advantage of this service, and we look forward to hearing more about your plans in the future.

Dr. Box: Thank you for having me.

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