|Project ILBS Echo|
Project ILBS Echo – Multiplying Capacities In Healthcare
Reaching out to underserved populations in healthcare is a huge challenge for both developed and underdeveloped nations. Healthcare providers are unevenly distributed geographically, concentrating mostly in urban and metropolitan regions, leaving out vast gaps in semi-urban and rural areas. Providing specialist care is even more challenging than providing primary care, due to obvious reasons. This is despite the fact that the demand for specialist care is high even in underserved populations.
Physicians providing care in rural and isolated areas frequently care for patient populations with high rates of illness, including complex, chronic illnesses that they may not be fully equipped to treat effectively. In fact, the lack of access to high-quality specialty care services is often a major problem, particularly for uninsured.
Project ECHO (Extension for Community Healthcare Outcomes) is an innovative new model of health care education and delivery in New Mexico, USA, addressing the challenges of providing specialist level care in non metro settings. Established at the University of New Mexico Health Sciences Centre, Project ECHO is developing capacity for safe and effective treatment of chronic, common, and complex diseases in rural and underserved areas while monitoring outcomes to ensure quality of care. ILBS is the first institute to replicate this model in India under the aegis of ILBS-ECHO programme with a goal to identify, treat and manage liver related disorders across the country.
Using state-of-the-art tele-health technology and clinical management tools ILBS-ECHO trains and supports physicians in the community to develop knowledge and self-efficacy on a variety of diseases not usually considered within their scope of practice. As a result, these physicians can deliver best-practice care for complex health conditions in community-based sites where this specialty care was previously unavailable. Using the technology developed Project ILBS ECHO aims to build on and successfully implement the ECHO model to the Indian scenario.
How the Model Works
When a new partner site - a physician in a rural / semi urban area, for example—joins the network, ILBS-ECHO staff members first conduct a one-day, in-person orientation at ILBS, New Delhi. The orientation explains and provides the hepatitis C treatment protocol as well as the communications technology and the case-based presentation format for the weekly one-hour telemedicine clinics. Next physicians along with their assistants - are organized into disease-specific learning networks that meet weekly via videoconference to present cases. These “virtual grand rounds” or “tele-clinics” are led by a team of ILBS specialists, who review and discuss cases with them.
Let us say a patient at a remote site gets diagnosed with Hepatitis C at a partner physician’s clinic. First the patient’s physician presents that patient’s information during Project ILBS-ECHOs Hepatitis C TELE-ECHO Clinic. The patient is not presented to the specialist in person. Presentations by remote partners are done using video-conferencing equipment or the telephone. Based on many patient factors, such as; alcohol usage, weight, smoking, and other health issues, the provider is given a treatment plan for the patient. These plans range from starting hepatitis C treatment to waiting for other complicating issues to resolve (6 months of sobriety, weight loss, etc.). Once cleared, the patient can start treatment. The provider follows the hepatitis C treatment protocol and presents the patient’s treatment status at important mile stones or when a health-related issue may impede treatment. The specialist then may change the treatment plan to maximize the patient’s chance of cure.
The hepatitis C team from the ILBS includes a hepatologist (liver specialist), a pharmacist, a psychiatrist, and a nurse. These specialists do not assume the care of the patient; in fact, the team from the Health Sciences Centre never even sees the patient. Instead, through a guided practice model, the remote partner retains responsibility for managing the patient, operating with increasing in-dependence as his or her skills and self-efficacy grow.
Web-based disease management tools facilitate consults, and specialists and remote partners jointly manage complex chronic liver illness for patients, who are treated right in their home communities. A secure and centralized database monitors patient outcomes.
Connecting One To Many
Project ILBS-ECHO is not a traditional telehealth model that facilitates a one-to-one connection between a doctor and a patient using technology. Rather, Project ILBS-ECHO builds altogether new and permanent capacities by developing specialist expertise where it previously did not exist. It is not one to one, but one to many.
In addition to improving access to specialty care in remote locations, Project ILBS-ECHO connects isolated physicians with colleagues, including specialists at academic medical centres. It delivers continuing education and improves remote partner’s satisfaction and retention in areas where it is often hardest to keep them. What’s more, participating physicians can earn continuing education credits at no cost, as well as certification in treating diseases such as hepatitis C. They also gain access to specialty consultation in a range of areas relevant to their practice that they did not have before.