America and Australia share some common geographical features. We both occupy massive land areas. Our populations are largely concentrated on the eastern seaboard. Our specialty physician capacity is largely centred around teaching hospitals in the largest cities. Our funders and policy makers live in some of the most affluent and educated parts of the country. So what can we learn from each other regarding overcoming some barriers to accessing high quality care?
There is a new movement in America. It is called Project Echo. The goal of those behind Project Echo is to reach a billion lives by 2025, and they are well on their way. When you are working from a base at the University of New Mexico that means to achieve your goal you must think and work very differently. Their process involves giving away their methodology, resources, even power to ensure that other clinicians can benefit.
Project Echo is not about telehealth. They use hardware typically associated with telehealth, however, the audience is clinician to clinician. Most importantly, the model is about a group of specialist mentors linking with an entire network of interested primary care provides in a disease or solution area. Therefore, Echo is a many to very many relationship rather than the one to one usually associated with telehealth. The purpose of the model is to distribute knowledge about core approaches or diseases to the outposts so that more care can be provided in primary care and in geographically isolated areas.
The Echo I watched today was centred on HIV. Clinical groups from five states and even Namibia participated. A short didactic on a topic of interest was delivered first followed by four case presentations contributed by the primary care teams in the field. The specialty panel in Seattle asked questions and provided some expert input…but so did a number of the other participants who had worked with similar cases. All the notes will be written up and disseminated. The PowerPoint of the technical content will be added to a mushrooming technical library. A number of Infectious Disease Doctors were present, not because they were paid, but simply because they learn something and enjoy being part of a voluntary and expanding community of interest. In addition, technical input is available from a psychiatrist, pharmacist and a social worker.
I have watched other Echos this week in other states. Their areas of focus spanned Endocrinology, Hep C, TB and Complex Care. The panels assembled reflected the demands of the clinical process. In all cases, between six and 40 primary care sites were involved in the one to two hour interactions. Some occur weekly, others fortnightly or monthly depending upon patient numbers and interest. The great news is that patients have to travel less for care, primary care physicians feel encouraged to develop some sub-specialty expertise because they are supported, holistic case input is achieved so better patient outcomes result and it saves bucket loads of pain and money.
The model has been adopted a a growing number of countries and a vast number of clinical applications. It is about to be applied to supporting police officers use community policing models to better manage interactions with mental health patients. Even refugee health is about to be trialed, connecting public health and immigration agencies, specialty physicians and primary care.
Even the American system has no discrete mechanism for funding Echo activity. However, some of the Echo projects have been running for more than 10 years so someone has listened to their need for sustainability. Will we hear the Echo of change in our landscape and embrace the concept? I hope so.
Tracey Johnson, General Manager, Inala Primary Care