Video Conferencing for Telementoring and Collaborative Care

"AHRQ funding allowed us to create technology-supported networks of continual learning and mentorship that bring best-practice care to people in rural and underserved communities."

When he received the Heinz Award for Public Policy in 2014, Sanjeev Arora, M.D., was recognized for revolutionizing community health care by “demonopolizing” specialized medical knowledge to produce the greatest good, using basic video conferencing technology as a platform for global telementoring and collaborative care.

A Distinguished and Regents’ Professor at the University of New Mexico Health Sciences Center (UNMHSC), Dr. Arora received the award for his Extension for Community Healthcare Outcomes project, known as Project ECHO. The project, which began in 2003 and was first awarded a grant from AHRQ to evaluate its potential in a randomized trial in 2004, brings evidence-based health care to rural and underserved patients by helping frontline providers acquire new skills and expertise via weekly virtual clinics with specialist mentors. ;

Project ECHO exponentially expands workforce capacity and reduces healthcare disparities by freely sharing best-practice medical knowledge with primary care providers. In this way, it has become a model for providing health care in remote areas of the United States, as well as overseas.

In July 2016, Project ECHO was selected as the basis for a new AHRQ initiative to provide treatment to Americans struggling with opioid addiction. Treatment to address this public health crisis uses innovative technology, including patient-controlled smart phone apps, remote training, and expert consultation. Several States, including Oklahoma, Colorado, and Pennsylvania, will use Project ECHO to provide urban specialists to train rural primary care doctors and for other forms of teleconsultation to improve opioid-addiction treatment.

Dr. Arora launched Project ECHO in 2003 when he realized that 28,000 people with hepatitis C in rural and underserved areas of New Mexico couldn’t get treatment for their condition. With AHRQ funding, Dr. Arora developed Project ECHO as a way to enable local health care providers to provide specialized treatment for hepatitis C, without having to refer patients to faraway specialists.

In Project ECHO, primary care providers—including doctors, nurses, physician assistants, nurse practitioners, and community health workers in rural and underserved areas and prisons—participate in weekly virtual clinics similar to grand rounds with multidisciplinary specialty teams located hundreds—or even thousands—of miles away.  In this way, community health providers acquire the knowledge and skills they need to provide high-quality care to patients who otherwise might not be able to get it.  Results have shown that patients get consistently high-quality care from these providers and that their outcomes are as good as if they had traveled hundreds of miles to the nearest specialist.

Although UNMHSC served as the first ECHO specialist "hub," Project ECHO currently operates 243 hubs in 48 States and 31 countries outside the United States, including within the Department of Defense’s Defense Health Agency and Veterans Health Administration healthcare systems. Other Federal Government partners include the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration.

"AHRQ funding allowed us to create technology-supported networks of continual learning and mentorship that bring best-practice care to people in rural and underserved communities," Dr. Arora said. "The AHRQ grant paved the way for expansion of the ECHO model within New Mexico.  Today, Project ECHO has partners all over the United States and around the globe."

Project ECHO has expanded across other diseases and specialties, urban and rural locales, different types of delivery services, and the world. In December 2016, the Expanding Capacity for Health Outcomes (ECHO) Act, a law that expands New Mexico’s Project ECHO as a national model for using telementoring for rural care, was signed into law More than 40 types of clinics address conditions ranging from chronic pain to rheumatoid arthritis to HIV. One clinic, Endo ECHO, is focusing on a new, more holistic way of managing diabetes and helping patients with the disease take control of their condition. Key to the Endo ECHO and many other ECHO programs is the use of community health workers to provide social and emotional support to patients and help them meet everyday challenges.

The ECHO model^TM of telementoring and collaborative practice has expanded treatment to underserved areas and helped countless people who otherwise would have suffered without medical care. In 2020, Project ECHO created a COVID-19 Collaborative and hosted numerous telementoring sessions in the United States and internationally to share best practices and information with public health officials, medical experts, and frontline providers to help them coordinate COVID-19 response strategies.

Principal Investigator: Sanjeev Arora, M.D., Founder and Director of Project ECHO/ECHO Institute
Institution: University of New Mexico Health Sciences Center
Grantee Since: 2004
Type of Grant: Various

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