By Etáin Quigley, Research Assistant, Change Team, ARCH

Connected Health has become many things to many people and can sometimes be difficult to pin down. Today I want to outline a simple but operational Connected Health initiative which has the potential to disrupt traditional methods of providing health care and as such is a prime example of where Connected Health solutions shine.

The Big Bad World has resulted in the stratification of health care provision and thus left a cohort of people in a position of relying solely upon state funded health care, a state of affairs which often results in individuals not being able to access the care they require, when they require it. This is no more evident than in the US, where health care has become something of a commodity. Those with minimal resources struggle to receive the level of care required to meet their basic needs, and as a result are more likely to suffer greater ill health.

Telemedicine

The State of New Mexico in the US has a particularly high level of citizens relying upon state funded health care. In 2003 some 34,000 New Mexicans were reported as having Hepatitis C with less than 1,600 receiving care (1). Moreover, underserved patients were waiting approximately 8 months to see a specialist and were required to travel up to 250 miles for appointments – patients may be required to attend up to 18 appointments during the duration of their treatment (up to 4,500 miles) (2).

Professor Sanjeev Arora MD from the University of New Mexico recognised that specialised care had become monopolised in academic medical centres and/or tertiary care facilities based in large cities, and that this had resulted in a cohort of patient being marginalised as a result of their geographical proximity and health insurance status.

The Extension of Community Healthcare Outcomes Project (ECHO) was developed to overcome these hurdles. It began in New Mexico by harnessing the underutilised expertise and commitment of Primary Care Practitioners and developing a co-management programme whereby experts/specialists in a field (in this case Hepatitis C) conduct a one-to-many telemedicine clinic once a week to Primary Care Practitioners.

The beauty of the system is its simplicity – it is simply telemedicine. However, what makes it novel, and what makes it work, is its ability to share knowledge related to various cases and thus co-manage patients at a local level, therefore reducing referrals to tertiary care.

Each week a number of Primary Care Practitioners submit a case for discussion. Those who do not submit a case may login to gain knowledge in the areas being discussed. The session begins with an evidence-based clinical update from the specialists and then the Primary Care Practitioners discuss their cases. This provides a platform for dialogue and knowledge exchange between all specialists and professionals involved in the session. This platform increases expertise in the area and promotes the confidence required to retain patients in the Primary Care System.

Connected Health can be many things and serve many purposes but if health care is viewed as a basic right, Connected Health has the ability to beat that drum – ECHO is a prime example of this! In 2014 the ECHO system was made available to interested parties at no cost and is now popping up across the globe in relation to a variety of conditions/diseases.

ECHO highlights that Connected Health has the ability to change how we do things, which is obvious, but it also has the ability change how we view things. ECHO is just one initiative which emerged from a man wanting to make health care a basic right to his fellow citizens. As my colleague Dr Maria Quinlan suggests in her blog Moving healthcare upstream – are we ready for that challenge and how can technology help? (12/02/2016) ‘”Digital healthcare can layer upon the existing patterns of inequality of race and income within our healthcare system, providing those who can pay for it with better care, while further marginalising those who can’t into a digital ghetto …or it can be a real force for change and equality.”

For more information see: http://echo.unm.edu/
And watch: https://www.youtube.com/watch?v=3OVVuFXoL0E

References

[1] RWJF Progress Report – Project ECHO: Bringing Health Care Without Walls to Rural and Underserved Communities (2014)

[2] ibid

You can contact Etáin on etain.quigley@ucd.ie or call 01 716 5410.

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