Sunday, July 15, 2012

Spotlight on VA's SCAN-ECHO

The Veterans Administration’s new nationwide pilot program called “Specialty Care Access Network-Extension for Community Healthcare Outcomes” (SCAN-ECHO) launch took place at a briefing in Washington D.C on July 11th. This new VA initiative is the first nationwide implementation of Project ECHO so discussion centered on how the ECHO model works plus how the project is going to transform healthcare delivery.

The ECHO model links primary care providers in local communities with specialist care teams at academic medical centers to help manage patients who have chronic conditions requiring complex care. The system uses video conferencing to conduct weekly virtual clinics operating like grand rounds at major teaching hospitals to educate doctors on the latest medical research and treatments. The primary difference in a SCAN-ECHO consultation is that other primary care providers have the opportunity to listen to the discussion, ask questions, and learn from the advice given.

Currently there are “teleclinics” on hepatitis C, chronic pain, rheumatology, addictions, psychiatry, asthma, pulmonary care, cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, geriatrics, palliative care, pediatric obesity, and heart failure.

Project ECHO is not considered traditional telemedicine that facilitates a one-to-one remote connection between a doctor and a patient. In fact, no patient is ever seen during an ECHO clinic. The ECHO project enables primary care clinicians to gain new competencies to provide care that was not previously available in their communities.

Robert A Petzel, MD, Under Secretary for Health at the VA reported that the VA is now treating six million veterans and over the next five years more than one million veterans will join the veteran community. The Under Secretary pointed out that rural veterans can now choose between face-to-face visits, telehealth visits, and today, the VA has more outpatient veteran centers and mobile fleets available to provide care.
“SCAN-ECHO is helping us to more fully harness the knowledge and expertise of our specialist physicians and extend that knowledge and expertise out into the field,” said Petzel. “This model empowers our primary care doctors, nurses, and other clinicians, and it strengthens VA’s ability to serve our nation’s veterans.”

Eleven VA medical centers are currently serving as SCAN-ECHO centers piloting the original project model across a range of chronic conditions and adapting it for use within VA. Also, the VA plans to finalize a strategic plan concept to help the VISNs that have not implemented Project ECHO move forward with the technology.

Also, as of June 2012, Project ECHO is working with DOD to create a global chronic pain management program for the armed forces. In addition, the Project ECHO received a three year $8.5 million Health Care Innovation grant from the Center for Medicare & Medicaid Innovation (CMMI) to expand operations in New Mexico and Washington State.   

Sanjeev Arora, MD, a liver disease specialist and leading social innovator at the University of New Mexico Health Sciences Center in Albuquerque created Project ECHO as a way to exponentially expand the health care system’s ability to treat patients with complex chronic illnesses. Over the past year, Arora and his team have trained more than 120 VA physicians, nurses and other primary care clinicians on using the ECHO model.

 Dr. Arora told the briefing attendees, that the ECHO model enables users to share best practices and obtain care-based learning. A multidisciplinary hub is located at the university, which creates teamwork and enables the flow of information to go back and forth between the university and primary care provides in the front lines.

The Robert Wood Johnson Foundation (RWJF) is supporting Project ECHO with a five year grant that aims to expand the model across the U.S. The project has also received support from the New Mexico Legislature, the University of New Mexico, and the New Mexico Department of Health. AHRQ has also funded an evaluation of Project ECHO that was published in the “New England Journal of Medicine In June 2011.

John R. Lumpkin, MD, Senior Vice President and Director of RWJF’s Health Care Group commented that the VA is the first healthcare system to embrace the ECHO model to help address some of the healthcare system’s most intractable problems, including access to care, workforce capacity, diffusion of best practices, and provider isolation.”

In addition, numerous federal agencies, health plans, healthcare systems, and Medicaid programs are in various stages of exploring or implementing Project ECHO. Even other countries are looking into the ECHO model. For instance, India and Brazil are already implementing the ECHO model plus other countries are giving the project serious consideration.

The VA will conduct an evaluation of the model’s impact on veterans’ access to care prior to system-wide expansion and Dr. Arora plans to continue his collaborative efforts with the VA, and be involved in the evaluation process.

For more information, go to or email