Rural healthcare providers who care for
patients with chronic complex conditions are often
challenged because of their own knowledge limitations.
Additionally, their patients — because of either long
specialty appointment wait-times or travel burden — are
unable to access urban specialty medical care.
In 2003, Dr. Sanjeev Arora, a liver specialist at the
University of New Mexico (UNM) in Albuquerque, saw the
direct impact of limited treatment capacity with respect
to hepatitis C, especially increased rates of liver
cancer in patients with untreated disease.
To remedy the situation, Arora drew on the basics of his
own medical training: medical education's iterative
guided learning, also referred to as
case-based learning. He created a "hub-and-spoke"
telementoring model by leveraging internet connections
and using webcams. He described the model as one that
"moved knowledge, not patients."
In the model, called Project ECHO® – or
Extension for Community Healthcare Outcomes —
disease-specific consultants and rural healthcare teams
met regularly, were able to learn from each other, and
also learned by providing direct patient care. This
created a "knowledge network learning loop." Hepatitis C
management capacity within the state increased
dramatically, due to what Arora terms was the project's
"force multiplier" effect. In 18 months, Arora's
hepatitis C clinic wait list had decreased from 8 months
to 2 weeks reflecting that the project's participating
primary care providers' ability to provide the required
care had been impacted.
With publication of the initial project outcomes in a
2011 New England Journal of Medicine article, Project
ECHO® became a landmark model of telementoring. Also
referred to as "technology-enabled
mentoring", due to hundreds of research papers
supporting the project's scalability, the model has
proven its effectiveness in the management of many
In 2012, a
trademark was obtained. In 2016, Congress passed
Public Law 114-270, "the ECHO Act," a public policy that
made Project ECHO® a national model for healthcare
collaboration in rural and underserved areas.
As of 2022, the Project is still managed by the
University of New Mexico. It has experienced major
expansion using a partnership model that is based on 4
- Amplification: Leveraging scarce resources with
technology and resulting in force multiplication that
increases disease treatment capacity
- Disparities reduction: Using best practices
- Promotion of understanding and management of complex
medical conditions: Using case-based learning
- Outcome monitoring: Using data collection to increase
impact by monitoring project programs and results
Over the last several decades, the model has engaged
partners which serve as experts in hubs and superhubs and
offer expertise on multiple medical conditions. Superhub
status is conferred after sustained activity as a hub.
Project ECHO partners also now use
iECHO, a "web-based partner relations management
tool" that allows for data collection, ECHO session
management, and the provision of online resources.
ECHO IT is another offering for the navigating the
nuances of the project's audiovisual technology platform.
New medical condition topics are selectively added to the
ECHO model if the disease is common, has complex
management options with outcomes being improved with an
evolving set of treatment options and new medications,
and has high societal personal and financial costs.
UNM ECHO projects include topics ranging from bone
health to first responder training.
Although Project ECHO's main focus has been health,
recent global events due to COVID-19 have allowed
expansion in New Mexico to the education and public
service arenas. Project ECHO is improving
education disparities by connecting teachers and
principals with experts in order to meet a specific
school's needs, culture, and students.
public service professionals can also benefit from
Project ECHO's platform. The Albuquerque police
department has become the first of its profession to use
the ECHO model to educate its officers on topics
associated with crisis intervention.
At its inception, support for Project ECHO® was
provided by the New Mexico Department of Public Health,
the New Mexico legislature, and the University of New
Mexico. Continuing to operate as a non-profit
organization, the project had also received grants from
the Robert Wood Johnson Foundation, Agency for Healthcare
Research and Quality (AHRQ) and its Minority Research
Infrastructure Support Program (MRISP), the GE
Foundation, and the Leona M. & Harry B. Helmsley
See the Robert Wood Johnson Foundation's early overview
of Project ECHO in this 5-minute video: