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Published Tuesday, March 26, 2019
by center for connected health policy

26 March 2019 via the Center for Connected Health Policy

Last month, the United States Department of Health and Human Servicesreleased a report to Congress on the “Current State of Technology-Enabled Collaborative Learning and Capacity Building Models,” in response to the 2016 Expanding Capacity for Health Outcomes Act (ECHO Act). The Act required the Secretary to provide Congress a report that would explore the impact of the technology-enabled collaborative learning and capacity building models on a range of health conditions, health workforce issues, implementation of public health programs, and the delivery of health services to rural and other underserved populations. To assist the Department in this effort, the Assistant Secretary for Planning and Evaluation contracted with the RAND Corporation to help evaluate the impact of existing models.

According to the report, “the ECHO Act defines a 'technology-enabled collaborative learning and capacity building model’ as a ‘distance health education model that connects specialists with multiple other health care professionals though simultaneous interactive videoconferencing for the purpose of facilitating case-based learning, disseminating best practices, and evaluating outcomes.’” These models are commonly referred to as “ECHO” projects. The originating model, Project Extension for Community Healthcare Outcomes (Project ECHO), was developed in 2003 at the University of New Mexico as a means to expand care for hepatitis C in rural areas. Project ECHO utilized video conference technologies to connect general practitioners in remote areas with specialists to treat complex or unfamiliar health conditions. Project ECHO has since been replicated and expanded to address a wide variety of other diseases and ailments across the United States and internationally.

Project ECHO and ECHO-like models (EELM) have received significant attention and funding due to its potential impact on the quality and access to health care. It is anticipated that these models will act as an educational tool for general care providers, in addition to improving the direct access and quality of care. By allowing general care providers and their patients to access specialty care providers remotely, patients receive better quality of care and doctors are given the opportunity to extend the range of conditions they are able to treat.

While the report acknowledged EELM’s positive impact toward improving healthcare services in remote communities, the evidence supporting its impact was very “modest.” The information collected lacked “standardization,” and did little to assess “the characteristics of individual implementations of the intervention as well as measurement of health outcomes.” However, the report noted that the lack of funding allocated to conduct evaluations contributed to these issues. Most funding for ECHO projects focused on implementing and launching a program and did not contain resources or requirements to evaluate outcomes.

As a result, the report made several recommendations to correct this deficiency, which include:

  1. To expand research by enhancing the capacity to perform evaluations.
  2. Improve the ability for organizations to perform evaluations through training centers.
  3. Focus future evaluations on ways EELM can improve the quality of care for conditions regularly treated by the primary care physician, in addition to care for more complex conditions.

For more information, view or download the full report