Expanding Telehealth and Telementoring During COVID-19: AHRQ’s Expertise Helps Identify Next Steps

While the COVID-19 pandemic has revealed troubling vulnerabilities in our healthcare system, it has also pointed to one area of immense benefit:  telehealth.

In recent weeks, we’ve learned more about how telehealth (or telemedicine) can help clinicians connect with patients when in-person medical visits are impractical or ill-advised. Indeed, in March the Federal Government expanded Medicare payments for a wider array of virtual office, home, and hospital visits, as well as mental health counseling and preventive health screenings.

But while the benefits accrue for these innovative techniques to connect clinicians and patients, my AHRQ colleagues and I are enthused to see support growing for an Agency-supported model that’s expanded use of telehealth’s complementary cousin: telementoring.

The model is called the Extension for Community Healthcare Outcomes, or Project ECHO—a telementoring approach that brings expertise to patients in medically underserved areas.  Developed by Sanjeev Arora, M.D., a liver specialist at the University of New Mexico Health Sciences Center, Project ECHO uses video conferencing technology to connect specialty physicians (at academic medical centers, or “hubs”) to train primary care physicians (the “spokes”) about the most effective ways to tackle complex diseases.

Dr. Arora described the origins of Project ECHO in a June 17 hearing (PDF) before the Senate Health, Education, Labor, and Pensions (HELP) committee, chaired by Sen. Lamar Alexander (R-TN). Dr. Arora created Project ECHO in 2003 after seeing a patient who delayed her treatment for hepatitis C for 8 years due to the long distances and waits to consult a specialist. Her advanced liver cancer caused her death within months.

In 2004, AHRQ funded Dr. Arora’s evaluation of Project ECHO based on the outcomes of more than 400 hepatitis C patients treated by primary care clinicians in rural areas. Results, published in the New England Journal of Medicine, found that the model was an effective way to treat hepatitis C in underserved communities, and held potential for widespread adoption.

The widespread use today of Project ECHO is nothing short of inspiring. It consists of 250 hubs in 48 states and another 130 hubs around the world. After starting as a tool to broaden access to treatment of hepatitis C, Project ECHO now trains clinicians on management of 70 diseases, covering diabetes, HIV, behavioral health, substance abuse, chronic pain, opioid management, and more. 

As Dr. Arora explained at the HELP committee hearing, Project ECHO has provided daily training sessions to more than 200,000 healthcare professionals on many aspects of treating COVID-19 since the pandemic began this spring. Dr. Arora explained the critical role that Project ECHO has played in training clinicians in a video interview AHRQ conducted with him on the project.

Applying ProjectECHO to the COVID-19 Pandemic (47 seconds)

Alternative Audio Described Version (47 seconds)

As the COVID-19 pandemic emerged, the Project ECHO model focused educational sessions to address the lack of evidence-based information available during virtual clinical rounds. During these sessions, clinicians with experience treating patients with COVID-19 from hospitals in New York, Washington State, and other hot spots shared their challenges and insights. Questions and answers that emerge allow experts and generalists alike “to learn from each other,” Dr. Arora told the Senate.

By mid-April, more than 7,500 people from 50 States and more than 30 countries had participated in a Project ECHO clinical rounds session. In addition, single-topic sessions have been devoted to ventilator support preparedness, diagnostic tests, physician well-being, and readiness by the Indian Health Service, among others.

Telehealth is already redefining how care will be delivered in the future. Millions of Americans have learned to use these new technologies during the COVID-19 crisis, and studies have shown early indications of both success and patient satisfaction. As a result, discussions are already underway to make telehealth a more permanent part of the healthcare delivery ecosystem.  

As the Nation prepares to bring to the American people safe and effective care for the post-COVID-19 era, it’s critical that policymakers, health systems professionals, and patients understand not only the proven benefits of telehealth and telementoring, but also the enormous impacts that may come from their expansion.

As we look ahead to broader application of these impressive innovations, some key questions to address include:

• What training is needed for healthcare professionals and patients to use telehealth successfully?
• How should telehealth be integrated and coordinated with in-person care?
• How can telementoring of healthcare professionals be used to expand implementation of evidence and best practices?
• Which healthcare services are most effectively transferred to virtual visits?
• How can providers and policymakers use telehealth to decrease disparities in healthcare access and increase equity in health outcomes?

AHRQ’s initial funding of Project ECHO and our role as the Federal Government’s lead patient safety agency underscore our commitment to identifying what works and what doesn’t. We firmly believe that telehealth will become a key tenet of 21^st century care, and that AHRQ’s role in promoting care that is safe, effective, and of high quality will continue to grow. We stand ready to contribute to this critically needed knowledge in the months ahead.

Gopal Khanna, M.B.A., is Director of AHRQ.

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