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Case Study

Project ECHO | The ECHO Effect: Moving Knowledge Not People

In 2003, Dr Sanjeev Arora, a gastroenterologist began treating patients for Hepatitis C in the state of New Mexico in the US. New Mexico is a geographically large state, with a low population density, under twenty people per square mile. Many people in rural areas were medically underserved and when he began treating patients in his clinic in Albuquerque, he could treat maybe 150 patients a year, and there was an eight-month waiting period to see him!

So he decided to try something new. He formed a learning community by bringing in primary care physicians and nurse practitioners from rural areas of New Mexico, that he and a panel of expert doctors would meet with for a couple of hours every week online through video conferencing. They would present cases and there was a communal sharing of expertise and learning. This became a project – Extension for Community Healthcare Outcomes or Project ECHO, launched in 2003.

Using proven adult learning techniques and interactive video technology, the ECHO Model™ connects groups of community providers with specialists at centers of excellence in regular real-time collaborative sessions. The sessions, designed around case-based learning and mentorship, help local workers gain the expertise required to provide needed services. Providers gain skills and confidence; specialists learn new approaches for applying their knowledge across diverse cultural and geographical contexts. As the capacity of the local workforce increases, lives improve.

source: https://echo.unm.edu/data/movement

The ECHO model effectively moves knowledge rather than moving the people, the patients, or the doctors, and it’s different in the way it imparts skills. What distinguishes ECHO from all other modes of distance learning is it’s incredibly high social element – all of ECHO’s learning takes place in the context of a social community. ECHO believes that humans learn better in a community, and people learn better when they’re working as a group to solve a problem.

The ECHO model has been highly effective in increasing the reach of scarce expertise – and consequently improving patient care, reducing costs and stress, and most importantly expanding the reach of medical care to underserved areas. By unlocking scarce resources – knowledge in the case – that can be reproduced in many different contexts, and for many different applications, ECHO has stayed focused on empowering practitioners through their journey. 

Case study: Cancer Screening in India: Sharing Knowledge to Combat Fear and Build Hope

In 2019, Project ECHO set a vision of improving the lives of 1 billion people around the world by December 2025. 400 million of them would be from India from ECHO sessions in healthcare, education, water and other verticals with a primary focus on health.

While the existing ECHO Model was powerful at its core, their methods of replication and partner support were not sufficient to drive the growth they needed to reach 1 billion lives by 2025. 

ECHO Digital: Reimagining ECHO as a Societal Platform

Today, ECHO has partners in India and 40 other countries. To reach their goal of 1 billion people by 2025, ECHO is designing a Societal Platform, ECHO Digital, that will transform their ability to scale. 

ECHO Digital will support a community of practitioners and innovators to reimagine some of the core aspects of Project ECHO:

  • Eliminate barriers to entry into the ECHO movement: Until 2019, almost all ECHO partners travelled to their hub locations like Albuquerque or New Delhi for in-person training, often from other continents, and associated paperwork and travel costs can be significant. ECHO Digital is making it far easier for aspiring partners to join them by combining the best of online learning with key elements of the high-touch training that makes ECHO what it is.
  • Accelerate adoption and launch: ECHO Digital will make it easier for participants to get up and running quickly and cost-effectively by providing tools for the performance of all phases of an ECHO Program. It will empower partners to inspire and onboard participants into their ECHO learning communities. It will provide a seamless environment for the running of ECHO sessions, including measuring attendance and managing case-based and lecture content.
  • Amplify the impact of existing network operations: ECHO Digital will enhance the productivity of ECHO’s existing network and support its sustainability by disseminating core tools and knowledge. The new one-stop environment for managing ECHO programs will support our learning communities beyond the in-person sessions with tools for asynchronous communication, learning, discovery and social networking. ECHO Digital will help measure the impact of ECHO programs, by providing data and the tools to analyze and visualize them, and support the sharing of ECHO stories, key to amplifying the work of partners.
  • Empower champions and build community: Project ECHO is a network of highly motivated experts and practitioners who go to great lengths to serve their communities as champions. They believe that the power of their community of innovators and sharers can be substantially enhanced by ECHO Digital by improving speed, scale, and sustainability, and it will empower their members with data, connections and a platform on which to share their accomplishments and impact. At the same time, this community will help be co-creators of ECHO Digital.

Through the adoption of Societal Platform approach, ECHO will invest in strong, high quality interactions within the teleECHO sessions and beyond them. Based on data and intelligence, they will be able to monitor, orchestrate and enrich interactions across the extensive network. Data could give insights on where value is created, and encourage replication of successful interactions across the movement. The value from core interactions will lead to network effects, and data will spur virality. Both crucial to scale. 

ECHO Digital will be a step forward to equitable healthcare for all. Initial experimentation is showing positive signs in: 

  • Amplification of impact to unlock scarce resources: The ECHO Model™ provides a platform for knowledge to be shared in an all teach and all learn environment. ECHO Digital will make ECHO sessions searchable as an anytime resource for those seeking knowledge both within and outside ECHO.
  • Enhancing participation in each session: ECHO Digital will help the teams  better understand the quality of interactions and enhance their ability to identify high-functioning and active participation among sessions, and even signal less than optimal participation. By analysing this, ECHO can drive various initiatives to enhance participation across all its sessions. 
  • Case based learning to master complexity: What if the knowledge sourced from thousands of ECHO sessions across the globe each day could be automatically transcribed for everyone’s reference? And automatically tagged based on sentiment, subject, relevance? 
  • Web based database to monitor outcomes: Using AI & ML to run comparative analysis to provide insights into what constitutes high-function or not, and where improvements can be made. ECHO Digital will also enable them to open information to the ecosystem to learn from and grow.
  • An interconnected web of knowledge & best practices: With an energized ecosystem, empowered by data generated through various sessions that will be qualitatively analysed – ECHO’s community will have access to reliable knowledge and resources that are global, open, relevant and contextual.

ECHO Digital will support everyone participating in Project ECHO and will reduce the human and financial costs of launching, running, and achieving improved outcomes by enabling a broad community of creators to contribute knowledge and tools to the movement. 

ECHO’s success is really about understanding how to scale learning – the right knowledge at the right time at the right place. And ECHO Digital is a move in this direction. Quoting Dr. Sunil Anand, Executive Director at ECHO India when interviewed for the podcast Sea Change, “How would you get this model in where people are not being taught? We’re not disseminating information, we’re helping you implement best practices. That’s the big difference it makes. So let’s say it wasn’t there – how would you train such a large number of people face-to-face? You cannot do it, right? Now, It’s not only video conference, the Echo Model by coming in and sorting out your problem. That’s how you will learn, right?” 

A video by Skoll Foundation: Using the ECHO model democratize medical knowledge and save lives around the globe