Project ECHO Brings Telehealth Clinics to Rural Communities, and the Next Step Is Experts on Call

telehealth clinics and rural communities

A few years back my brother and his wife took their 2-year-old son to the doctor after they noticed a strange lump on the gum above his teeth. The doc examined the boy, then looked up and made a puzzled face.

“Never seen that before. Let’s have a look on Google.”


You Google Nicki Minaj lyrics.

You Google paper airplane designs.

You Google how to eat soup without slurping.

You don’t Google the medical diagnosis of a 2-year-old. Certainly not in front of his hyperventilating parents. The kid is fine (just an icky abscess), but my brother now consults a different doctor. It’s hard to have confidence in a physician whose research matches your own paranoid internet searching.

It highlights just how broad the cases are that we present to our local doctors, and how much wisdom we assume they possess. While they have done well at school, work long hours, and read complicated medical journals, these are mere mortals nonetheless, not superheroes.

Let’s find them someone to turn to when they encounter the unfamiliar.

Telehealth Across the USA

The U.S. Senate is helping doctors get in touch with experts when they need advice. In November it passed legislation to expand the reach of a University of New Mexico telehealth program to deliver support to rural doctors.

Called Project ECHO (Expanding Capacity for Health Outcomes) the program uses video conferencing to create virtual clinics, with a specialization in the treatment of Hepatitis C. These weekly clinics offer local doctors the chance to meet with specialists and academic medical centers to gather new knowledge and treatment methods.

Initially launched in 2003, ECHO now links 3,000 doctors, nurses, and community workers, and treats 6,000 patients.

The Senate funding will better link the program with health systems across the country, giving remote doctors even greater resources with which to support their local communities in areas where a doctor can find himself being all things to all people.

It will also become the foundation for a national model of support for rural doctors.

A Nationwide Web of Medical Experts

Roll out the Project ECHO model across the country, prioritizing doctors in remote communities and you could provide expert treatment to everyone living out of ready driving distance of a major hospital.

In addition to weekly virtual clinics, you could establish a list of on-call specialists, whether dermatologists, neurologists, gynecologists, or epidemiologists, that doctors could turn to when they get stumped by a presenting case.

With the use of an HD webcam, and there are some good ones available for less than you’d imagine, a doctor could move with dexterity around a patient, and enable a three-way conversation that could get to the bottom of a diagnosis, or at least lead to the right tests. Equipment, like stethoscopes and otoscopes, that can send data via the internet to another doctor would take things a step further, making diagnosis easier.

This method doesn’t increase the access to specialized equipment, but at least it removes a potentially wasted trip to seek out such facilities in the event they ultimately aren’t needed, and lets both the patient and doctor know how serious the issue might be.

Reaching a Remote Medical Specialist

So let’s try that opening scenario again.

This time when the doctor rises with that puzzled expression the words are a little different.

“Never seen that before. But I know a dentist on the east coast who specializes in young kids. Let’s Skype him.”

It doesn’t even matter if the desired colleague is currently available. Your doctor can leave a detailed video message, complete with a probing close-up of the unknown ailment. Everyone goes on with their day, with the parents waiting on a call–maybe a video call if they have a smartphone–to tell them what to do about the now-diagnosed lump.

But it’s better if the remote angel on the doctor’s shoulder is available.

Under that scenario the specialist can ask about the kid’s diet and behavior, can see first-hand how he responds to contact on the affected area, and can direct his virtual colleague to point the camera anywhere they know to look. And they can request any specific tests right on the spot while everyone is still in the room.

Now, that’s a more comforting consultation for everyone.

And no one needs to look for a new doctor the next day.

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