American Telemedicine and Project ECHO

Abstract

Purpose: This project seeks to demonstrate how and why, from an historical perspective, the ECHO care model was successful and how it compares and differs from its telemedicine antecedents. Methods: This project collected and analyzed Project ECHO’s primary literature and its leaders’ narratives via interviews. These data were couched within a narrative drawn from primary and secondary documentation contextualizing ECHO's developments within, and its effects on, American telemedicine history. Results: American telemedicine grew with technological development in the 20th and 21st Centuries, and primarily sought to overcome distance in medical treatment. Telemedicine could not increase total treatment scale which, in addition to programs’ financing limitations, inherently limited the modality. In 2003, Project ECHO innovated a telemedicine care model which directly addressed treatment scale, especially for HCV, and has since been replicated nationally and globally. Preliminary data show potential cost savings for Medicaid patients with complex, chronic disease. Conclusion: ECHO greatly increased treatment for HCV and other disease sets, but it also scaled treatment with equal or greater efficacy at the level of the PCP than by centrally based specialists. Telemedicine programs historically found difficulty obtaining durable financing; ECHO has also not yet solved this structural barrier.