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Once in a while in my line of work, you catch a glimpse of genius.
In my role at the GE Foundation, I am lucky enough to meet pioneers with a global vision for health and sustainable development. What these leaders have in common is their unique ability to recruit others in their quest for societal change. Leadership begins with sharing a vision with many people in numerous communities from diverse walks of life.
This rare genius truly shines in Dr. Sanjeev Arora, the creator and founder of Project ECHO. In 2003 this collaborative learning model grew out of Dr. Arora’s frustration that he could serve only a fraction of patients in New Mexico with hepatitis C. At the time, he was one of the few liver disease specialists in the entire state of New Mexico, and arithmetically, he would never be able to care for those patients in time to have a difference in their health. So he conceived of and launched Project ECHO.
Simply put, Project ECHO is a new system for transferring specialty care knowledge to primary care providers. It’s medical rounds on steroids. At the start, a team of specialists with a deep knowledge of hepatitis C gathered virtually in a conference room at the University of New Mexico Health Sciences Center. In that conference room would be a video screen with a matrix of individual primary care providers who were sitting in their own offices and clinics across New Mexico. Each provider would, in turn, present their patients with hepatitis C and get guidance on caring for each patient from the experts at the university hub. Each of the other providers learned from every case presentation.
Now, 13 years later, Project ECHO is more than a model; it has become a movement. It encapsulates 94 academic and expert hubs worldwide (58 in the United States and the rest in 16 other countries), and it covers more than 60 complex conditions.
What I’ve learned from Project ECHO and Dr. Arora is that the strength of a movement is not only about the disruption of the innovation or the brilliance of an idea; it’s also about the tenacity and courage of its followers. As American entrepreneur Derek Sivers said during a TED talk he gave on creating a movement, “If you really care about starting a movement, have the courage to follow and show others how to follow.”
Aside from the clear benefits to patients and providers, what’s been most amazing about Project ECHO is the way communities have mobilized around the tool. Project ECHO is now being deployed in Boston to build the capacity to care for patients struggling through the horrible stigma and complexity of substance-use disorder. According to the Massachusetts Department of Public Health, more than 1,500 deaths in Massachusetts in 2015 were attributable to a fatal dose of heroin or an opioid-based painkiller — nearly four people per day statewide. We must strengthen the ability of primary care providers to treat substance use and address lingering stigma.
In addition, Project ECHO is now being used in law-enforcement education and to teach quality improvement for health care centers. In fact, ECHO can be used to teach any nonphysical or knowledge-based skill, using its tele-mentoring, case-based method. I like to think of Project ECHO as an operating system, akin to Apple’s. Much like Apple, ECHO clearly has its fair share of die-hard champions. Just as Apple created a movement that has reached massive numbers of people with the simplicity and beauty of its operating systems, so too is ECHO being adopted.
The Project ECHO movement will continue to grow. It has only begun to tap its potential for sharing knowledge throughout the world.
David Barash, MD
David Barash, MD, is the chief medical officer and executive director for global health at the GE Foundation.
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