Increasing Access Through Telehealth and Project ECHO

Providing adequate healthcare access to rural areas has been a growing problem in the United States. With more than 48 rural hospitals closing since 2010, and almost another 300 in danger of closing, a solution to mend the access gap in rural areas is dire. However, the emergence of the ECHO Act has provided an answer.

Several reasons account for the demise of healthcare in rural communities: reduced populations, long distance travel, higher percentage of uninsured and elderly patients, equipment underuse, and the unavailability of certain specialties. Additionally, rural hospitals encounter staffing issues because many doctors are unwilling to work in remote areas, which further creates quality of care concerns.

Many hospitals around the U.S. now use some form of telehealth to solve this access problem. There are around 200 telemedicine networks connecting large health centers in urban areas to about 3,000 rural sites. These networks provide specialty consultations, continuing medical education (CME) to providers, and may be used in emergency and critical-care facilities.

Telemedicine has also gained bipartisan support in Washington, with Congress passing the ECHO Act on November 29, 2016. The ECHO Act would expand the University of New Mexico’s Project ECHO (Extension for Community Healthcare Outcomes) as a national model. Project ECHO is a collaborative model of medical education and care management that inspires healthcare providers to deliver better care to more people. The University of New Mexico School of Medicine describes the ECHO model as

. . . dramatically increas[ing] access to specialty treatment in rural and underserved areas by providing front-line clinicians with the knowledge and support they need to manage patients with complex conditions such as: hepatitis C, HIV, tuberculosis, chronic pain, endocrinology, behavioral health disorders, and many others. Clinicians are engaged in a continuous learning system and are partnered with specialists from academic medical centers or hubs.

Project ECHO was originally launched in 2003 as a “hub-and-spoke” model with experts educating local primary care providers and nurses to provide high-quality specialty care and treatment for patients in rural or underserved locations. Today, the ECHO model’s telementoring network serves as a pioneer for creating better access in other states with expansive rural communities. Project ECHO is unique because it focuses on training rural doctors, nurses, physician’s assistants, and other clinicians to help them stay current with advances in chronic diseases.

The passage of the ECHO Act will promote telehealth expansion nationally by mandating that the Department of Health and Human Services (HHS) study Project ECHO’s impact on patient care and clinician development. Additionally, the ECHO Act requires HHS to deliver a report to Congress on the ease of integration of the ECHO model, any barriers to its use, and HHS’s recommendations for solving these challenges.

The overwhelming bipartisan support of the ECHO Act further brings issues with health care delivery access in rural communities into the national spotlight. Because the primary goal​ of Project ECHO is to provide the same level of care in rural areas that is available in larger cities with specialty medical practices, bringing this goal to a national level through the ECHO Act will hopefully increase the access and quality of patient care across the country.

Although still in its infancy, the national expansion of the ECHO model to increase telehealth across the country will hopefully provide better access to those in rural communities and close the ever-increasing access gap to underserved populations.

Cristina Mares is pursuing her law degree at DePaul University College of Law in Chicago. Cristina completed her undergraduate degree at the University of San Diego in Communication Studies and Spanish. She is an active member of the Health Law Institute, and the outgoing Business & Managing Editor for the DePaul Journal of Health Care Law. She would like to focus on the regulatory and compliance side of healthcare law after graduating in May of 2017.