Editor-in-Chief, Chester 'Trip' Buckenmaier III, MD, COL, MC, USA.

Recently, the Pain Task Force visited the University of New Mexico (UNM) ECHO^™ (Extension for Community Healthcare Outcomes) project directed by Sanjeev Arora, MD. The ECHO initiative was designed to develop innovative methods to treat chronic and complex diseases in medically-underserved areas throughout New Mexico. Using modern video-teleconferencing (VTC) technology, specialty leaders for a given medical problem such as chronic pain (in this example) are linked weekly to a network of primary care pain champions throughout rural New Mexico. These rural providers present challenging pain cases from their locations and are provided specialty advice on management and treatment plans. Since the VTC link involves many different rural sites at the same time, everyone learns from the case presentation and discussion. Case discussions are followed by a didactic presentation on some new aspect of pain management from the recent literature. The UNM also offers continuing medical education credits for all participants in the weekly program. 

The brilliance of the ECHO project lies in its relative simplicity. Using VTC technology, patients are able to receive specialty health care services from the professionals that they know within their own community hospitals. Primary-care providers feel less professionally isolated in their remote locations and are empowered as they provide state-of-art care for their patients with readily-available advice from specialists, while they gain recognition as local experts within their communities. Over time, primary-care providers involved in the project become increasingly adept at managing pain issues locally, rely less on the network and are better at referring appropriate patients for specialty consultation. The ECHO system is certainly not limited to just pain management; at UNM, ECHO also is used to facilitate management of hepatitis C, diabetes, heart disease and other major health issues.

The Pain Task Force leadership quickly recognized how this program would be a “force multiplier” for specialty care availability throughout DoD. Currently, DoD is collaborating with ECHO experts to replicate similar programs throughout the military health care system. The Veterans Health Administration (VHA) also has recognized the power of the ECHO system. According to Rollin “Mac” Gallagher, MD, Deputy National Program Director for Pain Management, VHA Central Office, VHA is executing an implementation plan for ECHO pilot projects in five regional centers. In addition, the VHA is collaborating with the DoD in the development of a pain-education curriculum to be utilized as part of the ECHO educational component.

The ECHO program represents an outstanding example of medical best-practices being positively coupled with modern technology to improve patient care. By facilitating our primary-care providers to function to the fullest extent of their license and training, we will be preparing federal medicine providers to supply a lifetime of superior patient care. Smart thinking, as expressed in the Chinese proverb, really never gets old. 

¹Buckenmaier CC III, Galloway KT. Military pain management: A cultural change for the 21^st century. 2011 Compendium of Federal Medicine – supplement to US Medicine. P. 18-22.

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