Project ECHO^® (Extension for Community Healthcare Outcomes)Connect with Expert Medical Specialists to Build Capacity in Primary Care and Reduce Health Disparities

1. Presents 5 STEPS to incorporate the Project ECHO model in your practice.

2. Answers commonly asked questions about adopting the model.

3. Provides tools and resources to help your team increase access to care for your patients.

Primary care physicians (PCPs) and other clinicians can provide excellent specialty care directly to patients from their own practices. Project ECHO (Extension for Community Healthcare Outcomes) is a model originally developed at the University of New Mexico, creating a bridge between primary care clinics and specialist teams at academic medical centers through weekly virtual meetings, called TeleECHO clinic sessions. The goal of these sessions is to build a community of practice, learning, and support by sharing knowledge to increase treatment capacity.¹ This approach saves time, adds convenience, and improves treatment adherence for patients. In doing so, it simultaneously increases the knowledge, mastery, and joy of medical practice for clinicians.

Since the launch of Project ECHO, initial results and responses have been enthusiastic. In 2016, the U.S. Congress passed the ECHO Act (Pub. L. 114-270) with strong bipartisan support to further federal study of the intervention. In February 2019, the U.S. Department of Health and Human Services released a Report to Congress evaluating Project ECHO.² As identified in the report, Project ECHO has spread far beyond New Mexico; there are now more than 160 sites across the country and internationally, covering a wide variety of health conditions that “many clinicians feel under-equipped to address”.² The ten most common health content areas covered are mental health, opioid and other substance use disorders, chronic pain management, hepatitis C, autism spectrum disorders, cancer care, palliative care, HIV/AIDS, and diabetes.

1. Learn More About the Project ECHO Model.

2. Identify Topics That Are Unique to Your Practice or Patient Population.

3. Connect with Project ECHO and Join a TeleECHO Session.

4. Present Patient Cases in a TeleECHO Clinic Session.

5. Apply What You've Learned to Treat Patients in Your Practice and Continue Participation.

Quiz Ref IDProject ECHO was initiated in 2003 in response to extremely long waits for hepatitis C care and a lack of specialty clinicians in the state of New Mexico. A prospective cohort analysis of the initial Project ECHO hepatitis C virus (HCV) program demonstrated that the model is a viable and an effective mechanism for treating HCV infection in underserved communities.³

Project ECHO has become a lifelong learning and guided practice model developed precisely to address these types of concerns. The model has expanded to hundreds of partners across the United States and internationally, covering more than 60 clinical topics.³

The model is a low- or no-cost, high-impact intervention that links primary care clinicians with expert interdisciplinary teams in other specialties through TeleECHO clinics. Experts mentor their primary care colleagues to manage complex patient cases. Expertise is shared via case-based learning, guidance, feedback, and education.

“ECHO is really the main inspiration I have in my professional life today.”

—Henry Cohen, MD, Uruguay

Four principles comprise the Project ECHO model. The combination of these principles results in a unique and successful approach for improving clinician satisfaction, enhancing clinician knowledge and self-efficacy, and improving patient satisfaction and outcomes:

1. Use technology to leverage the expertise of a multidisciplinary team.

2. Share best practices to reduce disparities and standardize care.

3. Leverage case-based learning and guided practice to master complex cases.

4. Apply web-based tools to monitor outcomes.

Project ECHO is not just a learning and mentoring network; it is also a professional community. Participants are encouraged to ask questions, provide input and guidance to one another, and engage actively in discussions, both during and after a TeleECHO clinic session.

Project ECHO can exponentially increase a practice's workforce capacity to provide specialty care by moving knowledge rather than moving patients. Over time, primary care clinicians operate with increased independence as their knowledge, skills, and self-efficacy grow. Implementation of this model has also revealed that when patients are treated in their local communities by clinicians they know and trust, it enhances their adherence to treatment and follow-up care. The Project ECHO model has also been shown to improve clinician professional satisfaction.

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Create a planning committee or team that will identify areas where there is a need for increased access to specialty care within your practice. The committee should include clinicians from various disciplines, as well as administrators who can work with your practice or organizational leaders to identify access shortage areas. It is very important that clinician special interests be included in this planning phase, as Project ECHO is a learner-centric model. Once the planning committee has identified a particular clinical need or target area, you can connect to Project ECHO and join a learning network in your topic area of interest and in your geographic region. You can find a list of all of the TeleECHO programs in the United States by visiting their interactive and searchable program database.

There are currently more than 430 ECHO Programs, covering topics from behavioral health to cancer diagnosis, endocrinology to neurology, military health to rheumatology, and many more.

Project ECHO offers virtual TeleECHO clinics in specific areas of interest and in your geographic region. They can answer questions and provide you with more information to help you decide if they fit your practice needs. Project ECHO has a wealth of resources available to help you connect to more than 100 TeleECHO clinics across the US and around the world, each offering different specialty areas.

“I think the idea of being part of a movement that's going to reach a billion people is lofty. I know there's a huge need out there and just understanding that the current tools that we have are not sufficient to meet the demand, the demand of expanding medical knowledge and expanding need, is daunting. ECHO is probably the best idea to meet that demand.”

—John Scott, MD, MSc, University of Washington

CME from TeleECHO activities may be available from the sponsor site for each TeleECHO clinic session attended, and some institutions are now offering maintenance of certification (MOC). For example, Johns Hopkins University School of Medicine offers MOC for a Sickle Cell TeleEcho Conference Series. Cincinnati Children's Hospital Medical Center offers MOC for an online course entitled STORM TeleECHO, for Sickle Treatment and Outcomes research in the Midwest. These course offerings may change over time, as more organizations begin to offer MOC for physician participation in the work.

To connect with Project ECHO and join a TeleECHO clinic, visit the Project Echo website. The Join an ECHO page has all the information that you will need.

Quiz Ref IDProject ECHO links expert specialist teams at an academic hub with primary care clinicians in local communities. Primary care clinicians then become part of a learning community, where they receive mentoring and feedback from specialists. Together, they manage patient cases so that patients get the care they need.

Many benefits exist for physicians and their practices once they join a TeleECHO Clinic Session, as detailed below in Table 1.

All TeleECHO clinic sessions are case-based, so each will use a disease-specific or topic-specific case presentation template to assist you in structuring and presenting your complex patient case. Most TeleECHO clinic sessions are held for 1-2 hours per week depending on the clinical topic area.

You may want to watch some brief instructional videos on the best way to present patient cases in a TeleECHO clinic session.

Recommended video: The Correct Way To Conduct An ECHO Patient Presentation

Recommended video: Project ECHO: Sample Weekly TeleHealth HCV Clinic

You may also want to review some examples of preparation forms and presentation templates used by participants in their TeleECHO sessions:

After participating in several TeleECHO clinic sessions, you will have the skills and knowledge to help many of your patients yourself or to discern when their conditions are so complex that they will need to be referred. Through your Project ECHO partners, you will have access to specialists in your region, which is helpful for triaging the most urgent and complex patients.

Project ECHO is a self-paced learning model whose target audience is comprised of primary care clinicians and multidisciplinary care teams in the community. Individuals participate in TeleECHO clinic sessions on a regular basis, often for many months or years, especially in rapidly evolving, complex disease areas. Over time, participating community clinicians begin to receive referrals from other community clinicians, creating an effective triaging system in their region.

“I enjoy ECHO immensely. I enjoy seeing all of the nurses and being able to talk to them all and to find out problems or issues maybe with patients that they have not otherwise brought to our attention. Now that we are doing ECHO, I don't know how we did it without ECHO.”

—Deborah Isaacs, Nurse Consultant, New Mexico Department of Health

Project ECHO moves specialty knowledge into the community to help primary care clinicians care for patients with complex health conditions, expanding the care these patients can receive from the clinicians they know and trust. The interactive virtual learning platform, TeleECHO, brings expertise to clinicians where they practice so they can grow their skill set and increase workforce capacity to provide best-practice specialty care and reduce health disparities.⁵