Wide open spaces

Rural docs and specialists pool knowledge in OSU-COM’s Project ECHO

The interactive online program empowers rural health professionals to care for patients who have limited access to specialist care.


On a January day in Tahlequah, Oklahoma, primary care physician Douglas C. Nolan, DO, is gearing up for an important lunch date. Although some of Dr. Nolan’s patients have mental health issues, his employer, Cherokee Nation Health Services, doesn’t have an onsite psychiatrist. But today, as he does every other week, Dr. Nolan will spend his lunch in a two-hour interactive videoconference with psychiatrists from the Oklahoma State University Center for Health Sciences College of Osteopathic Medicine (OSU-COM) in Tulsa.

After listening to a brief presentation, Dr. Nolan and other rural health care professionals will present de-identified patient cases to their specialist colleagues for guidance, and listen as other primary care health professionals do the same. After the session, those who presented patient cases will receive a written copy of the specialists’ recommendations.

Joseph R. Johnson, DO

Connecting rural health care professionals with specialist expertise is the goal of OSU-COM’s Project ECHO, says Joseph R. Johnson, DO, the program’s medical director. So far, the university has launched modules on psychiatry and obesity, with groups for addiction medicine and HIV/Hepatitis C slated to begin in February. After that, the project will expand to include women’s health, hospital administration and correctional medicine.

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Project ECHO at the Cherokee Nation

Jorge Mera, MD, the director of infectious diseases for Cherokee Nation Health Services in Oklahoma, is a Project ECHO veteran—and a big fan of the program. When Dr. Mera took on his role at the Cherokee Nation in 2011, he learned that an estimated 3,000 patients needed treatment for hepatitis C. In response, Dr. Mera and his colleagues joined a hepatitis C ECHO run by the University of New Mexico. Eventually, they launched their own hepatitis C ECHO hub at the W. W. Hastings Hospital, in Tahlequah, Oklahoma, with eight Cherokee Nation health clinics as the spokes.

Jorge Mera, MD

“Over the past few years, we’ve trained more than 20 health care professionals, who in turn have treated more than 500 patients with hepatitis C. What we’ve achieved would have been impossible without Project ECHO,” says Dr. Mera, who was honored by the White House for his work on the project. With the launch of OSU-COM’s Project ECHO, he says, his colleagues at Cherokee Nation Health Services will have even more access to specialist expertise.

‘It’s a multiplication effect’

Douglas C. Nolan, DO

Dr. Nolan says participating in OSU-COM’s psychiatry ECHO is enabling him to provide specialist-backed mental health care in a trusted local setting–a key distinction for some patients. “If I tell a patient with severe anxiety that he has to drive a long distance to a large, busy city for care, chances are he’s not going to do it,” Dr. Nolan says, noting that travel can also present a financial hardship for some patients. Moreover, with Oklahoma’s department of mental health cutting its budget by $13 million in 2016, the state’s psychiatric resources are already stretched thin.

Joseph R. Johnson, DO, medical director for OSU-COM's Project ECHO, explains the model in this news clip from Oklahoma Horizon TV.

For Dr. Johnson, one of the most exciting aspects of Project ECHO is that as greater numbers of rural primary care health care professionals receive training, exponentially more patients will have access to specialized care. “Under the telemedicine model, if I’m a specialist, the primary care doctor refers the patient to me and I take over that person’s care,” Dr. Johnson says. “But with Project ECHO, I teach local doctors how to practice as a specialist and then allow them to continue caring for their own patients. It’s a multiplication effect.”

Dr. Nolan, who plans to join OSU-COM’s addiction medicine ECHO next, sees the same potential to touch many lives. “For my patients with addiction issues, receiving care could be life-changing,” he says.

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