By Jonathan Woodson, MD, Assistant Secretary of Defense for Health Affairs
Technology advances — particularly the use of telemedicine — continue to change how Americans receive their healthcare, where they receive their healthcare and the organizational models for managing their healthcare.
The Military Health System long has been a pioneer in using telehealth to connect our global force with the most well-trained specialists in our system. Whether it’s on the battlefield, at sea or in the air — Army, Navy and Air Force medicine have introduced and accelerated the use of telehealth capabilities for all of American medicine.
Still, our system is a learning system, reliant on the two-way exchange of information. Initiatives in the civilian sector are informing how we can continue to exploit technology in ways that allow us to reach remote populations here in the U.S., as well, and connect primary-care providers and specialists in more-effective ways.
The MHS is about to embark on a new telehealth project known as Project ECHO (Extension for Community Healthcare Outcomes), an initiative developed by Dr. Sanjeev Aurora at the University of New Mexico, and our partner in this endeavor.
Project ECHO involves a colocated, multidisciplinary team of specialists who use regular video teleconferences to mentor a number of primary-care providers in multiple locations — using a hub-and-spoke model. The University of New Mexico has introduced ECHO clinics at 32 hubs in the United States and six more in India, Canada and Northern Ireland.
The Robert Wood Johnson Foundation has taken note of the University of New Mexico’s success at increasing the ability of primary-care providers to manage patients with chronic conditions and complex care needs, enabling thousands of patients to be served in remote or medically underserved communities. The Foundation is providing more than $5 million in grant money to expand the concept, both nationally and globally.
DoD has also taken note — and will build upon early successes piloted by the Army, which established ECHO hubs at four military installations: Eisenhower Army Medical Center, Womack Army Medical Center, Tripler Army Medical Center and Landstuhl Army Medical Center. All sites have focused on pain management — an important area for military medicine. The pain-management team includes specialists in medicine, orthopedists, pharmacists and physical therapists and includes assessment of both traditional and alternative medical therapies, such as massage, acupuncture, biofeedback and yoga. The initial DoD rollout will continue with this focus area, then expand into several additional specialty areas.
Within the Army pilot, Project ECHO has brought several advantages. It allows primary-care providers to manage cases that previously would result in referrals to either private-sector providers, or distant military specialists. It improves the patient experience by allowing patients to get more of their care closer to home. And, it provides DoD with the ability to optimally use both its primary-care and specialty providers in ways that improve the clinical skills of both — improving readiness and lowering costs.
Project ECHO is only one example of the MHS’ commitment to innovation and the expansion of strategic partnerships with our civilian colleagues. The MHS will continue to identify opportunities for incorporating technology into our daily practice of medicine, allowing our medical staffs to expand their own skills in effectively managing care in even the most remote locations.