VA project joins physicians via telemedicine to expand care delivery

Primary care physicians and specialists will work together using telemedicine in an effort to provide high-quality, complex care to veterans who receive care via the Department of Veterans Affairs (VA) system, regardless of where they live, under a new model of medical education and healthcare delivery.

Unlike traditional uses of telemedicine, however, the Specialty Care Access Network–Extension for Community Healthcare Outcomes (SCAN-ECHO) initiative will foster provider-to-provider communication, not provider-to-patient communication.

“Project ECHO is a completely new way of sharing medical knowledge and providing medical care,” says Sanjeev Arora, MD, at the University of New Mexico Health Sciences Center in Albuquerque, who created Project ECHO as a way to expand the healthcare system’s ability to treat patients with complex chronic illnesses.

The VA’s SCAN-ECHO initiative is the first nationwide implementation of Project ECHO. The ECHO model links primary care providers in local communities with specialist care teams, often at academic medical centers, to manage chronic conditions in patients who require complex care. It uses videoconferencing technology to conduct weekly virtual clinics, which operate like the grand rounds used by major teaching hospitals to educate doctors on the latest medical research and treatments.

During the clinics, primary care providers from multiple sites present their cases to the specialist teams, discuss new developments relating to their patients, and determine treatment. Specialists serve as mentors and colleagues, sharing their medical knowledge and expertise with the primary care providers.

Primary care teams participating in ECHO are part of an online learning community, where they develop the skills and receive support to provide comprehensive, complex treatments for patients where they live. The goal is to have these teams become new, community-based centers of excellence.

“By making best practices and mentoring support widely available to primary care providers, it expands the healthcare system’s ability to provide care for very high-need patients. We call this the ‘force multiplier effect,’ ” Arora says.

Eleven VA medical centers are serving as SCAN-ECHO centers, piloting the original Project ECHO model across a range of chronic conditions and adapting it for use within the VA:

• VA Connecticut Healthcare System, West Haven, Connecticut

• VA Pittsburgh Healthcare System, Pennsylvania

• Hunter Holmes McGuire VA Medical Center, Richmond, Virginia

• Salem VA Medical Center, Salem, Virginia

• Louis Stokes VA Medical Center, Cleveland, Ohio

• VA Ann Arbor Healthcare System, Ann Arbor, Michigan

• New Mexico VA Healthcare System, Albuquerque, New Mexico

• VA Eastern Colorado Healthcare System, Denver, Colorado

• Portland VA Medical Center, Portland, Oregon

• San Francisco VA Medical Center, California
• Veterans Integrated Service Network in California (services split between VA Greater Los Angeles Healthcare System and VA San Diego Healthcare System)

“SCAN-ECHO is helping us to more fully harness the knowledge and expertise of our specialist physicians and extend that knowledge and expertise out into the field,” says Robert A. Petzel, MD, VA under secretary for health. “This model empowers our primary care doctors, nurses, and other clinicians, and it strengthens VA’s ability to serve our nation’s veterans.”

The VA will evaluate the model’s effect on veterans’ access to care before deciding whether to expand the program access the VA system, but the model previously has proved successful in care delivery. An evaluation funded by the federal Agency for Healthcare Research and Quality and published in the New England Journal of Medicine in 2011 showed that the quality of hepatitis C care provided by Project ECHO-trained clinicians was equal to that of care provided by university-based specialists. A study published in Health Affairs in 2011 found that the program reduced costs for physicians and patients.

Although the VA is the first to implement the ECHO model on a national scale, the model is being adopted elsewhere, too. In May, the U.S. Department of Health and Human Services awarded a 3-year, $8.5 million Health Care Innovation grant to enable Project ECHO to expand its operations in New Mexico and Washington state. In June, the Department of Defense announced its intention to use the model to manage chronic pain in the armed forces. In addition, the Robert Wood Johnson Foundation (RWJF) is funding replication of the model in Washington state and in Chicago, Illinois, and announced a 5-year grant that aims to expand the model across the United States.

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