VA telemedicine pilot has specialists training rural primary care docs

The Department of Veterans Affairs (VA) announced this week the launching of a three-year, $15 million pilot to test the potential of providing long-distance specialty training and support to rural primary care providers who treat veterans.

Called Specialty Care Access Network--Extension for Community Healthcare Outcomes (SCAN-ECHO), the program is being tested at 11 VA sites across the country. Panels of medical experts in 14 different specialties will conduct 90-minute weekly training sessions for primary care physicians by video conference. The specialists analyze and suggest solutions for specific cases that the primary care doctors are working on.

The aim of the project is twofold: to help patients get the benefit of specialty care without having to travel long distances to academic medical centers, and to help specialists take care of more patients by working with their primary care providers.

SCAN-ECHO is based on a successful rural telemedicine program, Project ECHO, that was started 10 years ago by Sanjeev Arora, a liver specialist at the University of New Mexico Health Sciences Center (UNMHSC) in Albuquerque.

Supported by grants from the state of New Mexico and the Robert Wood Johnson Foundation, Project ECHO grew to encompass more than 250 sites, the majority of them in New Mexico, according to an article in Chronic Pain Perspectives. Among the virtual "clinics" for communities and prisons in Project ECHO are training sessions for asthma, dementia, diabetes, hepatitis C, high-risk pregnancy, palliative care, and pain management. Participating providers use videoconferencing equipment where it's available, and telephones or webcams where it isn't.

In a study of Project ECHO published in the New England Journal of Medicine in 2011, it was shown that the long-distance training program enabled primary care providers to achieve outcomes for treating hepatitis C that were comparable to those of specialists at the medical center in Albuquerque.

According to the VA, the Veterans Health Administration has established a collaborative agreement with Project ECHO to educate and provide training materials to VHA staff. In addition, Project ECHO staff will be available for consultation as the VA program expands.

The VA previously has used telemedicine to do neurological assessments, treatments, psychiatric interventions, and occupational and and physical rehabilitation of veterans with traumatic brain injuries.

In the past decade, the VA also has established an extensive home telehealth program. A 2008 VA study showed that, in conjunction with care management, home telehealth reduces hospital admissions and bed days, according to an article in InformationWeek Healthcare. But the SCAN-ECHO project appears to be a new departure for the VA.

To learn more:
- read the VA announcement
- see the Chronic Pain Perspectives article
- check out the NEJM paper on Project ECHO
- see an InformationWeek Healthcare piece on the VA home telehealth program