Three years ago, Karen Edison, MD, a dermatologist with MU Health Care, traveled to the University of New Mexico with a group of state representatives and other doctors to learn about an innovative new program that was training doctors in rural areas to better recognize and treat serious conditions. Edison brought the program back to Missouri, and today the Show-Me ECHO Program is transforming the medical care provided to Missouri’s most underserved populations.
What is ECHO?
“ECHO stands for Extension for Community Healthcare Outcomes,” Edison says. “It is an education program that allows primary care providers in rural and underserved areas to connect with multidisciplinary specialty teams around certain diseases or specialty areas to improve the care that they deliver to their own patients.”
For example, a primary care doctor in a small town in northwest Missouri might notice that many of her patients end up in the hospital with asthma attacks. The ECHO Program can provide her with weekly training with a team of asthma experts so that she can recognize and treat the condition before her patients end up in the ER.
The Show-Me ECHO Program currently offers training to primary care doctors for chronic pain, autism, asthma, dermatology, hepatitis C and child psychiatry. “We’re currently looking for funding for high-risk obstetrics, rural veterans’ mental health, resistant hypertension, congestive heart failure, Parkinson’s disease and antibiotic stewardship,” Edison adds.
How does it work?
Every Friday from noon to 1 p.m., Edison sits down in a conference room with the rest of her dermatology ECHO team: herself, two pediatric dermatologists, a dermatopathologist, two other general dermatologists, a clinical psychologist and a nurse practitioner. Participating doctors have already sent the team questions about the patients they are treating in their own rural or underserved practices.
“Doctors participate using a phone, an iPad, a laptop or a computer,” Edison says. “From our end it looks like the Brady Bunch. They all show up in little video boxes on our screen.”
For the first 10 to 15 minutes, participating doctors can eat their lunch while Edison and her team go through the latest research and treatments in their field. Then they tackle the cases that doctors have sent in. “We're a multidisciplinary dermatology team, and we all give input,” Edison says. “And our participants give input as well.”
How is it changing medical care in Missouri?
Edison has been practicing telemedicine for years, but she says the ECHO Program has a much broader impact. “When I’m taking care of a patient through telemedicine, I’m taking care of one patient at a time,” she says. With the ECHO Program, she’s training doctors who can then serve a whole community. “So it’s the difference between giving a man a fish and teaching him to fish. It’s about demonopolizing your expert knowledge.” Primary care doctors are better able to identify and treat conditions in the early stages, which helps patients stay healthier in the long run.
It’s also saving money. “Our asthma program by itself, we’ve found, over two years will save about $8 million in decreased hospitalizations and emergency department visits,” Edison says. “We’re seeing a decrease in those in the counties where there is an asthma ECHO.”
Another benefit of ECHO is improved retention of providers in those underserved areas “because when you go out and practice [in a rural area], it’s a little bit lonely sometimes when you don’t have anybody to bounce things off of,” Edison says. Having a group of other primary care providers and an expert team to talk to every week makes doctors feel less isolated and allows them to share ideas with other providers.
Is it really saving lives?
Absolutely, Edison says. “In dermatology, I taught my participants to take off the shirts of men 50 and older and look at their backs, particularly men who live alone. And they’ve already found three early melanomas by doing this.” Early-stage melanoma has a survival rate of more than 98 percent. If it is not found before it spreads to other parts of the body, the survival rate is only 18 percent.
How can I support the program?
You can write to your state representatives to make sure they know you care about funding for the ECHO Program. You can also ask your primary care doctor if they are participating in ECHO Programs.
“It's about educating people to do better,” Edison says. “People really want to know more, and they want to do better for their patients.”