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Michelle Iandiorio, MD

Medical Director, HIV ECHO

Associate Professor, UNM DOIM, Div ID

Project ECHO®

New Mexico

Supported by New Mexico Department of Health, Agency for Health Research and Quality, New Mexico Legislature, the Robert Wood Johnson Foundation, the GE Foundation and Helmsley Trust

Democratize medical knowledge and get best practice care to underserved people all over the world.

Expand workforce capacity

Expand access to primary & specialty care

Utilize multidisciplinary approach

Disseminate best practices

Engaging learners in continuous learning system & partnering

them with specialist mentors

Mission

Improve the lives of 1 billion people by 2025.

http://echo.unm.edu

TedX Talk: https://youtu.be/lY5nlJxac0g

https://youtu.be/H3qy3B4YMaM

Goal

Moving Knowledge Instead of Patients

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Copyright 2015 Project ECHO®

• Use Technology to leverage scarce resources

• Sharing “best practices” to reduce disparities

• Case based learning to master complexity

• Web-based database to monitor outcomes

Arora S, Geppert CM, Kalishman S, et al: Acad Med. 2007 Feb;82(2): 154-60.

MethodsTeleECHO Clinic

Specialist Manages Patient RemotelyTraditional Telemedicine

Patients reached with specialty knowledge & expertise

ECHO Supports Community Based

Primary Care TeamsECHO Telehealth

ECHO vs. Telemedicine

Started in 2009 (Project ECHO® started in 2003)

Weekly sessions: Tuesday 12-1pm MT

Short didactic presented by AETC faculty

Case presentations by participating providers (spokes)

Discussion among group & recommendations from interprofessional experts from around the state

Builds community of practice

Capacity building & mentorship

Project ECHO®-NMAETC

HIV TeleECHO Clinic

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Hepatitis C (2003) Complex Care

HIV Geriatrics

Endocrinology Palliative Care

Bone Health Tuberculosis

Chronic Pain CHW Specialist

Integrated Addictions & Psychiatry Prison Peer Educator

Women’s Health & Genomics

Successful Expansion

No cost CME, Pharmacy CE, Nursing CEU

Professional interaction with colleagues with similar

interests

Less isolation with improved recruitment & retention

A mix of work and learning

Access to specialty consultation with HIV experts,

pharmacists, mental health providers, case management,

etc

Benefits to Participants

Increase impact

Reduce wait times

Improve appropriateness of referrals

Improve relationship with community

Work with interprofessional team

Learn from community of practice/collaborative

Benefits to “Hub”

Copyright 2015 Project ECHO®

• Technology

• Force Multiplication

• Demonopolizing Knowledge

• Knowledge Expansion

Task Shifting

InterprofessionalConsultation

Guided Practice

Mentor/Mentee Relationship

Community of Practice(Social Network)

Joy of Work

Team Based Care

Movement Buildingvs.

Organization Building

What Makes ECHO Work?

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Renita Madu, PAhttps://www.youtube.com/watch?v=3FanE_Ud0xE&list=PLoL7mi3iOLMLO3BC_2M-ZkDgDYhLOW0Pn&index=11

ECHO Immersion Training3-day training

echoreplication@salud.unm.edu

Join the ECHO Movement

Overview of Project ECHO NevadaChris Marchand, MPH

Office of Statewide Initiatives, University of Nevada School of Medicine

June 10th, 2016

• Planning began in late 2010

• Rural road trips/site visits/needs assessment during July and August 2011

• First clinic launched April 2012 – Diabetes ECHO

Project ECHO Nevada Background

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• Mental Health Professional Development Group (Junior Clinicians)

• Mental Health Professional Development Group (Experienced Clinicians)

• Psychology Internship Supervision Group

• Marriage and Family Therapist Internship Supervision Group

For Behavioral Health Providers

• Sports Medicine• Gastroenterology• Public Health• Behavioral Health in

Primary Care• Pain Management• Diabetes/General

Endocrine• Antibiotic Stewardship• Rheumatology• Hepatitis C• Geriatrics

For Primary Care Providers

Project ECHO Nevada Clinics

• Nevada Rural Opioid Overdose Reversal (NROOR) Program

• HealthInsightBehavioral Health Initiative

• Project ECHO New Mexico Substance Abuse Expansion (MAT Training)

• Nevada Antibiotic Stewardship Program

ECHO-Nevada Collaborations

• Juvenile Justice• Wilderness Medicine• Nurse Practitioner

Supervision• Nevada Interscholastic

Activities Association

ECHO Clinics in Development

Project ECHO Nevada Clinics

1) Not enough primary care doctors

2) Not enough specialty doctors

3) Maldistribution of physician workforce

4) Geographic isolation of health care facilities

Challenges in Nevada

Diane McGinnis, APRN

Vickie Boll, PA-C

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Source: Nevada Rural and Frontier Health Data Book, 7th Edition. University of Nevada School of Medicine (2015).

Table 4.49: Population Residing in Health Professional Shortage Areas (HPSAs) in Nevada – 2015

Region/County

Population Residing in Health Professional Shortage Areas (HPSAs)

Population Primary Medical Care HPSAs Dental HPSAs Mental HPSAs

Number Percent of Population

Number Percent of Population

Number Percent of Population

Rural and Frontier

Churchill County 1,412 5.5 1,412 5.5 25,665 100.0 25,665

Douglas County 7,536 15.7 0 0.0 48,003 100.0 48,003

Elko County 3,520 6.4 10,779 19.6 54,993 100.0 54,993

Esmeralda County 959 100.0 959 100.0 959 100.0 959

Eureka County 2,069 100.0 0 0.0 2,069 100.0 2,069

Humboldt County 712 3.9 0 0.0 18,248 100.0 18,248

Lander County 6,708 100.0 6,708 100.0 6,708 100.0 6,708

Lincoln County 5,117 100.0 5,117 100.0 5,117 100.0 5,117

Lyon County 53,639 100.0 53,639 100.0 53,639 100.0 53,639

Mineral County 4,356 100.0 4,356 100.0 4,356 100.0 4,356

Nye County 45,081 100.0 45,071 100.0 45,081 100.0 45,081

Pershing County 7,031 100.0 7,031 100.0 7,031 100.0 7,031

Storey County 4,037 100.0 0 0.0 4,037 100.0 4,037

White Pine County 30 2.9 10,345 100.0 10,345 100.0 10,345

Region Subtotal 142,476 50.6 145,426 51.4 286,251 100.0 286,251

Urban

Carson City 51,186 92.9 0 0.0 55,098 100.0 55,098

Clark County 612,710 29.6 612,710 29.6 736,908 35.6 2,069,967

Washoe County 151,761 34.2 145,105 32.7 443,745 100.0 443,745

Region Subtotal 815,657 31.8 757,815 29.5 1,235,751 31.1 2,568,810

Nevada – Total 962,156 33.7 903,241 31.7 1,522,002 38.1 2,855,061

Sources: Health Resources and Services Administration (2015). Nevada State Demographer’s Office (2014a).

• Build the capacity of rural and frontier primary care workforce

• Reduce professional isolation and improve primary care recruitment and retention

• FREE CME and nursing CEU credits for rural physicians, P.A.s, nurses, and pharmacists

• Improve reimbursement to participating rural hospitals, clinics, and providers

Impact and Outcomes of Project ECHO Nevada

• Primary Care providers don’t have enough time

• Sparse mental health and substance abuse resources in rural Nevada put extra strain on their time

• Rural providers lack access to urban specialists

• Technology issues dissuade providers from participating more than once

Rural Provider Feedback on Barriers

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Chris Marchand, MPH

Project ECHO Nevada Program Coordinator

Office of Statewide Initiatives

University of Nevada School of Medicine

(775) 682-8476

cmarchand@medicine.nevada.edu

http://medicine.nevada.edu/echo

rces

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Logistics:

Behavioral Health

1 hour, once a week, noon

Pulse didactic

Case presentations

Use ECHO PPT resou

1 year schedule

Hawaii ECHOSession Date Attendees Sites # Islands

1/19 33 15 3

1/26 29 16 3

2/2 22 13 4

2/9 26 16 4

2/16 28 17 4

2/23 27 18 4

3/1 18 13 4

3/8 24 13 4

3/15 17 14 4

3/22 17 13 4

3/29 19 13 4

4/5 18 12 3

4/12 22 14 3

Started 1/19/2016

Hawaii:Behavioral Health ECHO

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Cost Per year Comments

Hub experts $20,000 per year per $100 per hour for

clinic specialists

Equipment $240 4 webcams, 1 mic,

purchasing ‘fancy

camera’ for $400

CME $10,000/yr $10 per person per

session

Coordinator $50,000+ Estimated $53K/yr

Banner $240 2 banners

tynectivi

Coordinator

Hub experts

CME costs

Minimal equipment, con

Costs? Where does the money

come from?Department of Health, different

departments ($54K to date)

CME and personnel-form AHEC

($40,000)

Hawaii State Rural Health

Association-applying for grants from

local healthcare foundations

Private insurance company-Wellcare

$7,000

Time consuming

Recruitment of spoke participants

Getting cases out of people

Arranging speakers

Make sure you eat if it is a lunch

session

Connectivity (actually rarely a

problem)

Consistency

Challenges

19)

a

Endocrine (12 weeks starting 2/

Integration of Primary Care and

Behavioral Health monthly

Geriatrics once a month

CHW training on dementia once

month

Pediatrics Subspecialties

Homelessness Eradication

School Health

New topics

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Suggestions

Multiple computers (one for PPT, one for

chat)

Have extra hub members in case of

vacations

Difficult finding a time to meet

Incentives for presenting

Teaching self muting and chat pays off

How to break into PPT for chat questions

Texting with coordinator initially

Case in PPT

Follow up?

Hawaii: echohawaii.org

Kelley Withy

Withy@hawaii.edu

/

New Mexico:

http://echo.unm.edu

Questions or Comments?