Project ECHO Takes On Rural Health Care Shortages

Nov 24, 2015

At a rural health center in Española, a doctor and a community health worker are huddled around a computer, taking notes.

On the screen is an array of squares. In one is a group of expert Albuquerque doctors specializing in addiction management, and in the others are rural medical teams from around the state.

It looks like the intro sequence to the "Brady Bunch," but the conversation is serious business: how to give top-quality care to patients suffering from addiction in areas where there aren’t any addiction specialists.

"I see way more patients than I feel like I should be doing. It just feels overwhelming sometimes," says Dr. Leslie Hayes from El Centro Family Health, a clinic serving Española and a handful of other small rural villages in the northern Rio Grande Valley.  

This town of 10,000 people has the highest rate of heroin overdose in the country, she says, and opiate and other addictions are some of the most serious public health threats here.

But addiction is a complicated condition that requires specialized training to treat, and the trained experts are an hour and a half away in Albuquerque—much too far for a lower-income patient to drive for treatment.

"We need a lot more specialists. Rheumatology, dermatology, psychiatry, all of those are really short up in this area," Hayes says.         

Which begs the question: How do you get specialized health care to places like Española, where there is so much need but so little expert help?

Dr. Sanjeev Arora, a hepatoligist in Albuquerque, thinks he has the answer: move knowledge instead of moving patients. 

Dr. Arora is the director of Project ECHO, the group running the video-conference at El Centro clinic. A decade ago, he had an idea that’s as simple as it is transformative: get a group of specialists together in a room at UNM in Albuquerque, and use video-conferencing technology to mentor rural doctors on how to give specialized care to patients using real cases in real time.

"Technology is the enabler," Arora says. "Normally, to do the kind of mentoring that we do, it would be so prohibitively expensive that it couldn’t be done. But because technology reduces the cost of doing that 10- to 100-fold, it allows this to happen."

If the idea of a medical video-conference sounds underwhelming, consider this: what the rural doctors and health workers on the call are actually doing isn’t just asking for expert help on treating difficult conditions. They’re working through complex patient cases together using each other’s knowledge and experience. That’s called case-based learning, which is the foundation of medical education.

The outcome is a growing cohort of rural doctors, nurses and health workers tele-trained to treat complex conditions. Those rural medical teams, Arora says, have had a big impact on the health care situation in rural New Mexico.

"It’s changed substantially," he says. "For many, many specialties—mental health disorders, addiction disorders, Hepatitis C treatment, and many other problems—there’s much better access to treatment."

But there’s still a lot of work to be done to fill the rural health gap both here and abroad. 

"This is a uniform problem from which 6 billion people suffer all over the world," Arora says. "The knowledge gets trapped in the heads of just a few experts in the world."

And that gives the idea of telementoring rural doctors a lot of appeal in other countries.

Dr. Nara Dashdorj is a physician from Mongolia who came to a recent ECHO training conference in Albuquerque. She’s looking to set up an ECHO network back home, because much like rural New Mexico, rural patients in Mongolia have trouble accessing specialty care since most of the medical specialists are in the capital city of Ulaanbaatar.

"The specialists in the rural areas are not well trained," she says. "So they are basically in only one place, in the capital city, so everyone in the rural area has to come to Ulaanbaatar to get care, and that’s very costly."

Dr. Arora and Project ECHO say their hope is to use the tele-mentoring model developed in New Mexico to transform rural health care globally.

That is an ambitious goal. But he’s off to a good start. Dozens of universities and hospitals in the U.S. and abroad have set up their own ECHO networks, and recently the American Academy of Pediatrics partnered with ECHO to train health workers around the world in child medicine.

Public Health New Mexico is funded by the W.K. Kellogg Foundation