Sharing information is at heart of new effort

WASHINGTON  -  Down with the need for lengthy commutes, transportation costs, and too much time waiting  -  the barriers that often decrease the quality of rural health are officially dissolving for the nation's veterans.

The VA has launched a new program known as Specialty Care Access Network  -  Extension for Community Healthcare Outcomes (SCAN-ECHO). The program, announced July 11, will leverage cutting-edge telehealth technology to provide specialty, comprehensive care to veterans nationwide, regardless of where they live.

The VA's implementation marks the first nationwide extension of ECHO.

Sanjeev Arora, MD, an innovator and liver disease specialist at the University of New Mexico Health Sciences Center in Albuquerque, engendered the initial spark for the ECHO project.

As a provider of chronic illness care for rural patients, Arora said his treatment was often stalled as patients struggled to commute to doctor appointments and pay for transportation. "I had the thought that if these patients had just come to me earlier, I would have been able to treat them better," he said.

To that end, Arora began working with other providers to leverage telehealth technology and share expertise. Soon ECHO projects spanned 19 areas of New Mexico, he said, and treatment quality showed "dramatic improvement."

Enter the VA, whose system of veterans seeking care includes many members in rural areas. "Rural veterans are less likely to have access to health services, particularly in the special care services that they may need," explained VA under secretary for health Robert Petzel.

The department wants to re-route this. Petzel says the SCAN-ECHO's program to generate communication and expertise across practices, and extend that quality to patients  -  wherever they are  -  presented a strong opportunity "to help veterans lead healthier, more fulfilling lives," he said, adding that "patients with complex problems like heart failure, chronic pain, diabetes can get high-level specialty care closer to their home."

At the crux of this care enhancement, Arora said, is the sharing of information. "The primary purpose in ECHO is not to treat individual patients, it's to generate expertise."

So, no  -  telehealth as a one-on-one interaction between a doctor and patient won't be realized in this case. Rather, the model connects specialist care teams to primary care providers in local communities. Through weekly virtual clinics, specialists and community providers will share expertise, treatment strategies, results, and the latest medical research to analyze their patient cases and develop solutions.

And that process has already been unfolding, and working. Naomi Clancy, a rural health doctor in New Mexico, was featured in a video shown during Wednesday's webcast. Her practice has been using Project ECHO conferences to better diagnose and cure patients. In particular, Clancy has been grappling with rheumatology, an area she's gained confidence in since working with experts through the Project ECHO model.

"It's a giant mind-center of collaboration," she said of her Project ECHO team. "This opened up a whole new field of medicine for me."

Eleven VA medical centers have implemented the original Project ECHO model to target and tailor treatment for veterans through SCAN-ECHO. The Robert Wood Johnson Foundation is assisting the Project ECHO with a five-year grant, with an eye on expanding the model to one that can be used nationwide in the future.

 "Case-based learning can occur over distances. You can improve the quality and care in underserved communities," said John Lumpkin, MD and senior vice president and director of the foundation's health care group. "We believe that ECHO has this new approach to innovation that will become the new normal in the healthcare system and help transform health care in this system."

So with its announcement this morning, Petzel thinks the VA is on the right track to align itself for a future of exceptional, accessible care - and dispel the struggles tied to rural medicine.

"America owes a debt of gratitude to these men and women who have served our country," Petzel said. "It is our duty to provide them the best and compassionate healthcare and expert treatment."