ECHO’s Statewide Impact
Telementoring Platform Connects Healthcare Workers with Specialists to Build Community and Ensure High-Quality Care Across Idaho — Pandemic Notwithstanding
Eight years sober, Tonya*, 41, has taken charge of her life despite decades of mental and physical health issues compounded by severe life stresses.
“I was subjected to abuse — all the different kinds of abuse — from when I was five to 15 years old,” Tonya said. “I became depressed and anxious very early on in life. My addiction started in high school as a way to escape my life.”
When Tonya began working with Andy Bradbury, M.D., she wanted to reduce her medications — a challenge given her history and the chemical interactions of her medication regimen. Bradbury, a physician and the chief medical officer for the Rexburg Free Clinic, found support for Tonya’s case through Project ECHO Idaho, a telehealth program that convenes healthcare professionals statewide to learn best practices from subject matter experts to help tackle some of Idaho’s most urgent medical problems.
Specialists who lead ECHO Idaho’s Behavioral Health series — which features an Idaho-based panel of experts in pharmacy, psychiatry, family medicine and mental health — advised Bradbury to increase some medications in order to slowly eliminate others.
“That advice has changed my life,” Tonya said. “With Dr. Bradbury’s support and guidance, I found momentum to begin changing dosage. Since my case was presented at ECHO, I’ve been able to get off all my pain medications as well as prescriptions that I don’t consider as vital, like allergy meds.”
Project ECHO (Extension for Community Healthcare Outcomes) is a program replicated worldwide to address regional healthcare concerns. Like Project ECHO programs everywhere, ECHO Idaho uses video conferencing over lunchbreaks to connect physicians, nurses, counselors, pharmacists and other professionals with specialists in regular, real time collaborative sessions.
Dr. Bradbury has observed a change in Tonya since they first began working together.
“Discussing what specialists from across the state recommended strengthened Tonya’s resolve and helped give her confidence to move forward in her treatment plan,” he said.
Dr. Bradbury continues to attend Project ECHO Idaho weekly.
“ECHO Idaho provides new perspective on difficult cases, reinforces some of my conclusions and allows me to proceed with more confidence,” he said. “I make time for it because it helps me stay in line with evidence-based medicine rather than risk drifting due to my solo practice in a rural area.”
Idaho’s ECHO Champions
The WWAMI Medical Education Program at the University of Idaho brought Project ECHO to the Gem State in 2018. Idaho WWAMI Director Jeff Seegmiller wanted to not only educate physicians-in-training but help expand the knowledge and abilities of Idaho’s practicing healthcare providers.
“A medical school should be the epicenter for knowledge and healthcare advancement for the region,” Seegmiller said. “Many people in Idaho’s healthcare community understood what Project ECHO could do for the state, but the program needed a champion. University of Idaho’s WWAMI program is that champion.”
Idaho Representative Caroline Nilsson Troy, R-Moscow, was also an early advocate of the ECHO model. A Vandal herself, Troy likens Project ECHO to the university’s land-grant mission.
“ECHO is a world-class, creative and clever program that can reach practitioners who may not have access to cutting-edge research and best practices,” Troy said. “It is the type of program that exemplifies land-grant thinking.”
The State of Healthcare in Idaho
Idaho’s need for improved healthcare is urgent. According to the Association of American Medical Colleges, the state ranks 49th for practicing physicians per capita, and the entire state is a designated mental health workforce shortage area according to the Health Resources and Services Administration.
“The reality of limited access to specialists means primary care providers end up treating patients with complicated conditions, but isolation in rural communities can make it difficult for providers to get professional development and support to provide care that follows the most up-to-date standards,” said Lachelle Smith, director of Project ECHO Idaho. “That’s the gap ECHO Idaho tries to fill.”
Rates of suicide and drug overdose deaths have steadily risen over the last 10 years and in many parts of the state are nearly double the national average according to the Idaho Department of Health and Welfare. Compounding these issues, many of Idaho’s healthcare professionals are nearing retirement and recruitment of young professionals to rural communities can be challenging.
“ECHO Idaho helps leverage different disciplines to work together to deliver top-notch patient care and participants develop camaraderie. The program has a ripple effect to build up the capacity of the existing workforce to help many, many patients,” Smith said.
As of June, Project ECHO Idaho connected 1,331 Gem State healthcare workers in 41 of Idaho’s 44 counties with expert-level education on opioid use, behavioral health, substance use in pregnancy and COVID-19.
ECHO Heard Throughout State During Pandemic
When the COVID-19 pandemic began sweeping the nation, ECHO Idaho was already a trusted source of state-specific healthcare information. With infrastructure to host virtual meetings, an experienced staff and an engaged network already in place, ECHO Idaho was able to design a COVID-19 program within two weeks.
“We could plan a high-impact COVID-19 program quickly because of support from the Vandal Community Relief campaign and partners like the Idaho Department of Health and Welfare,” Smith said. “We were intrinsically motivated to deliver facts about the disease to Idaho’s practitioners and administrators so they could make informed decisions on personal protective equipment, treatment options, infection control and more.”
ECHO Idaho’s initial COVID-19 session exceeded attendance records; 730 healthcare providers, educators and state leaders called in — including Gov. Brad Little. In anticipation of ECHO Idaho’s first COVID-19 session, Latah County Commissioner Tom Lamar invited all of Idaho’s county commissioners and other local elected officials and emergency managers.
“It’s critical to base our decisions on the science of the disease,” Lamar said. “ECHO Idaho gave us current information and directly influenced our actions.”
Frank Batcha, M.D., was one of the COVID-19 program panelists. Batcha is the assistant clinical dean for Idaho WWAMI and practices family medicine in Blaine County, where he also serves as the chief of staff at St. Luke’s Wood River Medical Center. Blaine County, home to 23,000 residents, made national headlines for its substantial per capita rate of infection — higher than both Italy and New York City.
“COVID-19 is too new to have subject matter experts,” Batcha said. “So, ECHO Idaho is important for two reasons: one, you have panel members who are accumulating and synthesizing the data that does exist, which is really important; second, you have people like me, who have an experiential perspective of the disease and can share information about what they’ve seen firsthand in hospitals and clinics.”
‘A Community of Knowledge’
ECHO Idaho is a simple yet innovative strategy to overcome healthcare challenges in Idaho and helps providers collaborate and support each other. Patients benefit from better care in their home community, and decreased costs can be realized through less travel time to see specialists, reductions in hospitalizations and unnecessary tests/labs.
“Along with reading, I think the way we assimilate information is from interaction with other people,” Batcha said. “Our pedagogic models are built on teachers who impart knowledge to students, who then interact and exchange ideas with each other. Project ECHO Idaho does that in an online forum every week.”
Seegmiller echoed Batcha’s sentiment.
“I love it when a rural clinician brings a challenging case for review and another ECHO participant on the call shares what worked for them in their rural town,” Seegmiller said. “We are discovering that there is a community of knowledge in Idaho, and when clinicians participate in this program, their clinical practice improves. That is the beauty of ECHO.”
* Name is changed for anonymity.
Boosting Rural Medicine from Texas to Idaho
For Dr. Byron Elliott ’81, who practices maternal and fetal medicine in Austin, Texas, giving back goes beyond providing scholarship support to Idaho WWAMI students. Driven by his passion for advancing rural medicine, giving back also takes the form of working directly with Idaho WWAMI to prepare future doctors to practice in underserved areas of Idaho.
This fall, Dr. Elliott began sharing his clinical expertise as a guest lecturer for Idaho WWAMI on the subjects of genetic testing, prenatal diagnosis and ultrasound.
“Though I have not practiced medicine in Idaho nor lived there since I was an undergraduate, I jumped at the opportunity to teach future physicians at the University of Idaho,” he said.
Article by Lindsay Lodis, WWAMI Medical Education Program
Published in the Fall 2020 issue of Here We Have Idaho.