Project ECHO Will Revolutionise Health Care Servicing in India

AHMEDABAD, September 5, 2014 /PRNewswire/ --

The ECHO project, designed and developed by Dr. Sanjeev Arora on the philosophy of 'moving knowledge instead of moving patients', has tremendous potential of providing health care services to the deepest rural health centers of the country.  Not only it has the potential to reach out to the rural areas but also reduce the costs for patients in rural locations since it is available locally and timely, so as to save the lives. Apart from the benefits to the patients in the deeper locations, it enables skill development of nursing and support staff of rural health centers in administering patients. It also helps improve and increase the knowledge of medical officers at the health centers whereby the specialists' knowledge gets disseminated to many more medical professionals. It has the multiplier impact when compared to Tele Medicine methodology of providing medical services.

ECHO project has been initiated at the following projects in India so far: MAMC-NACO Disha ECHO, India ECHO Autism Project, ILBS Hepatitis Project. These projects have been launched in association with reputed institutes like Maulana Azad Medical College, Delhi, Institute of Liver and Biliary Sciences - New Delhi, National Institute of Mental Health and Neurosciences (NIMHANS) - Bengaluru, and PYSSUM, a not for profit organization for Autism in Lucknow, among others.

The latest addition has been the Civil Hospital of Ahmedabad Municipal Corporation in association with National AIDS Control Organization (NACO) at Ahmedabad where the project has been launched for HIV patients. This project has been started in 26 antiretrovial therapy centres of Gujarat namely, Dahod, Chhota Udepur, Patan, Surendranagar, Jamnagar, Rajkot, Vadodara, Bharuch and Himmatnagar.  

Understanding Project ECHO and its origin 

Project ECHO is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases workforce capacity to provide best-practice specialty care and reduce health disparities. The crux of the ECHO model "is its bub-and-spoke knowledge sharing networks, led by expert teams who use multi-point video conferencing to conduct virtual clinics with community health care service providers. This enables primary care doctors, nurses, and other clinicians to learn to provide excellent specialty care to patients in their respective communities.

Chronic Hepatitis C is a disease that affects 3 million Americans and 170 million people around the world. Due to late detection of the disease, it remains the leading cause of cirrhosis and liver cancer, claiming 3,50,000 deaths globally. 

Dr. Sanjeev Arora realized that he would need to change the way he practiced medicine if he was going to prevent his patients dying from this deadly disease. A cure for the disease emerged in 1990 and by 2003, the cure rate was up to 70%. However, the few specialists in New Mexico who treated it were in urban centres, and most patients went without treatment. Those who sought help had to wait six to eight months to get an appointment in a clinic. Many could not afford to drive hundreds of miles to make an average of 12 to 18 trips to complete a course of treatment.

Dr. Arora was inspired to develop a system to 'demonopolize' health care knowledge. To move it out of the heads of specialists into networks of primary care providers in remote places so they could manage complex illnesses in their local settings. The core objective was for rural clinicians to provide care that was at par with specialists.

Dr. Arora set out travelling around New Mexico, recruiting local providers one by one, explaining how hepatitis C was killing their patients, that there were effective treatments for it, but they were complicated to manage. He made an offer that if they volunteered to spend two hours a week with him, he and other specialists would work with them in close collaboration until they could manage their own cases.

People came on board and Project ECHO came to life. In Albuquerque, Dr. Arora pulled together a team of specialists and they developed a model that combined video conferencing technology to facilitate weekly case based training (similar to the teaching approach in medical schools) with collaborative care and careful patient tracking. With funding from the Robert Wood Johnson Foundation, Project ECHO spread across the state.

Dr. Donald Berwick, the former administrator of the Centres for Medicare and Medicaid Services, who is currently running for Governor of Massachusetts, observed that Project ECHO's model represents a fundamental design shift - "from moving the patient to moving the knowledge. They've shown that with proper support the primacy care workforce, including nurses, not just doctors, can function to very high levels of precision with highly complex care."

In 2012, The Center for Disease Control and Prevention sponsored a replication of ECHO in Utah and Arizona, using the model to work with 90 primary care providers, 96 per cent of whom had never treated a single patient with HCV. Within a year, the proportion of patients treated in ECHO was twice the proportion treated in urban areas.

ECHO has also helped the Veteran's Administration set up 11 hubs connected to 600 clinics around the country. It's working with the U.S. Department of Defense to improve the way the Army manages chronic pain globally (video), and it recently formed a partnership with the Military Health System to setup ECHO projects within the Navy and Airforce.

Through a partnership with the Centre for Medicare and Medicaid Innovation, ECHO is also helping doctors, nurse practitioners, case managers and community health workers to prevent hospitalizations among patients with multiple chronic diseases in New Mexico and Washington. 

Over the past five years, Project ECHO has spread well beyond its initial focus. It now supports ECHO hubs anchored out of 31 universities assisting providers in more than a thousand clinics who focus on 26 specialties including rheumatology (video), H.I.V., addiction, women's health, hypertension, dementia, breast cancer, childhood obesity, diabetes and chronic pain. Besides the US, the model is also being used in India, Uruguay, The Irish Republic and Northern Ireland. 

About Project ECHO: A Revolution in Medical Education and Care Delivery 

Project ECHO is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases workforce capacity to provide best-practice specialty care and reduce health disparities. The heart of the ECHO model™ is its hub-and-spoke knowledge-sharing networks, led by expert teams who use multi-point videoconferencing to conduct virtual clinics with community providers. In this way, primary care doctors, nurses, and other clinicians learn to provide excellent specialty care to patients in their own communities.

Project ECHO started as a way to meet local healthcare needs by Dr. Sanjeev Arora, M.D., a liver disease doctor in Albuquerque. He created Project ECHO so that primary care clinicians could treat hepatitis C in their own communities. Launched in 2003, the ECHO model™ makes specialized medical knowledge accessible wherever it is needed to save and improve people's lives. By putting local clinicians together with specialist teams at academic medical centers in weekly virtual clinics or teleECHO™ clinics, Project ECHO shares knowledge and expands treatment capacity. The result: better care for more people. For more information visit, http://echo.unm.edu/

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