Yikes. Recent studies in reputable journals are not showing a benefit from telehealth:
In conclusion, in this unique study of 205 patients with multiple comorbid illnesses, there was no difference in combined hospitalizations and ED visits between patients receiving telemonitoring vs usual care.
While awaitng the answers to these questions, we would advise payers and physicians to move slowly in implementing telehealth programs on a wide scale.
That’s the result of telehealth set up to reduce hospital admissions and ER visits for very ill patients. (see: Takahashi PY Upatising B, et al PJL. A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Archives of Internal Medicine. 2012;172(10):773-779. and Wilson SR CP. Another sobering result for home telehealth—and where we might go next: Comment on “a randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits.” Archives of Internal Medicine. 2012;172(10):779-780.)
And then there’s ECHO.
I got to meet Sanjeev Arora, MD, in person yesterday, at the Department of Veterans Affairs launch of SCAN-ECHO, which stands for Specialty Care Access Network-Extension for Community Health Outcomes (press release here).
ECHO is not a telehealth program as defined by CMS, because it doesn’t connect a physician to patients remotely over video. It uses telemedicine technology, though. It is also not a 1:1 specialty-primary care teleconsultation program. It was not born from a desire to just reduce ER visits and hospitalizations. It is a case-based learning, network building, two-way, force multiplying, suffering-alleviating program. With great results, published in the most rigorous medical journals around (see: Now Reading: Breaking knowledge monopolies within the health professions to end suffering – Project ECHO | Ted Eytan, MD)
And now it’s expanding into the Veterans Affairs System, with 11 VA medical facilities serving as SCAN-ECHO Centers, with 35 teams in 14 different specialties. There’s an example of one of the VA SCAN-ECHO Sites here: About Us: Region 1 VA SCAN
As I was listening to Sanjeev talk about the program and answer a myriad of questions about how this needs to work to be successful, I was thinking, and I’m going to be honest here,
“This is what you get when a physician leads a program.”
By physician, I mean, a healer, a leader, a partner. A person who has seen suffering and works to prevent it; who owns the responsibility that society (who paid for most of our educations) wants them to have for the health of people; who thinks about supporting everyone on a health care team be their best in realizing their passion to care for others.
In his comments, he spoke about making a small investment in a primary care physician’s time and multiplying that many fold so that they could become “junior specialists” in their field. He said this starts as a one-way conversation, from specialist consultants to primary care providers, but then it becomes a two way conversation – because the primary care providers teach best practices based on providing the care. And so the network expands, so that every patient ultimately gets the best of both worlds: a specialist in the care of their condition, and a primary care physician who knows them. All in one.
ECHO is a program that began in the mind of a physician who saw needless suffering. Through the magic of the internet, you can actually access Sanjeev’s very first proposal for funding for this program, which was through Ashoka Changemakers, in 2007: Project ECHO: Knowledge Networks for the Treatment of Complex Diseases in Remote, Rural, Underserved Communities | Changemakers
This is not to say that there are no better leaders than physicians. Just that there are wonderful possibilities when this group of people, so invested in by society, can attach their passion to a system and change it.
The Robert Wood Johnson Foundation, which supported ECHO in 2007, recognizes this and invests heavily in physician, and all clinician leadership (I am a product of one of their programs myself). John Lumpkin, MD ( @jrlumpkin ) was at the launch representing RWJF.
Now, our Veterans will be another beneficiary of this work. Thanks for having me yesterday and I’m excited to see the ECHO model progressing so nicely.