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Telehealth Models for Promoting Workforce Education and Training

Telehealth can be used to help the rural health workforce overcome barriers to receiving education and training and allow providers to meet the evolving needs of their patients. Instead of traveling for continuing education, rural providers can access telehealth technology, such as videoconferencing, to receive face-to-face instruction and to demonstrate the skills they have acquired through distance learning. Many distance education courses use telehealth technology to deliver aspects of their curriculum. Providers in rural areas can also receive tele-mentoring from specialists located elsewhere in order to build their capacity to address complex cases.

Project ECHO

Project ECHO is an evidence-based telehealth program based in New Mexico that offers critical training and education opportunities to rural providers across the United States. Project ECHO's network enables providers from university medical systems and specialty care institutions to share information with the rural healthcare workforce. During weekly TeleECHO clinics, rural providers use videoconferencing technology to engage in case-based learning, consult with specialists, learn from fellow rural programs, and gain the necessary skills to meet the evolving needs of their communities. For example, Integrated Addictions and Psychiatry TeleECHO Clinics have provided physicians with the hours of training needed to qualify for prescribing buprenorphine under the Comprehensive Addiction and Recovery Act. The following projects also involve Project ECHO to train the rural workforce:

  • The New Mexico Prison Peer Education Project (PEP) uses telehealth technology to provide monthly continuing education sessions to peer educators at nine New Mexico prisons. PEP training allows inmates to educate peers about the prevention of infectious disease and imparts valuable professional skills that prepare participants for the workforce after they are released.
  • The School-based Consultations for Rural Pediatric Telehealth (SCRiPT) Network uses Project ECHO to provide training to staff at rural school-based health centers (SBHCs) in rural locations across the country. SBHC providers submit cases to the ECHO team, which includes a psychiatrist, psychologist, pediatrician, cardiologist, endocrinologist, and pulmonologist. During teleECHO clinic sessions with SBHC staff, ECHO experts review the case, provide guidance, and offer suggestions via video or teleconference.
  • The University of Kansas Medical Center is using Project ECHO as part of an initiative to address obesity and behavioral health concerns among children living in rural Kansas. The ECHO team works with rural providers and SBHC staff to provide teleECHO clinics on behavioral disorders, developmental concerns, learning conditions, and pediatric obesity. The ECHO approach is unique in bringing together participants across primary care, education, community mental health centers, and other child-serving systems. ECHO telementoring sessions are helping to build the capacity of SBHC staff to triage cases and effectively manage the health of students and for specialist teams to understand the resources available to families.
  • The Mountain West AIDS Education and Training Center uses Project ECHO to train rural providers in HIV patient care. Providers meet weekly with HIV specialists via interactive videoconferencing to discuss cases and receive guidance on treatment protocols.
  • The Kansas Asthma Initiative involves an asthma TeleECHO program that offers weekly tele-mentoring sessions to rural providers. The TeleECHO program aims to increase the ability of rural providers to adhere to asthma management guidelines and improve asthma control among their patients.

Other Examples of Workforce Training and Education through Telehealth

  • The Virtual Infusion Project in South Dakota trains nurses on evidence-based infusion safety standards to increase their capacity to administer chemotherapy and address the side effects of treatment. The project offers biweekly oncology education sessions through telehealth that allow infusion nurses to continue to build expertise.
  • The TeleEmergency program at Dartmouth-Hitchcock Medical Center offers educational training to hospital staff and emergency medical technicians across rural New Hampshire and Vermont. For example, physicians at the TeleEmergency center may use live video to observe nurses at a Critical Access Hospital performing a mock code simulation. TeleEmergency staff then provide feedback to the nurses and offer suggestions to continue to build their capacity to respond to urgent care situations. In addition, Dartmouth-Hitchcock Medical Center helps to build the capacity of rural hospital staff through the Center for Rural Emergency Services and Trauma (CREST), which uses telehealth to conduct case reviews and outreach rounds on topics related to emergency and trauma care.
  • The EMS Live@Nite program provides free monthly online trainings to law enforcement, healthcare providers, EMTs, paramedics, and other volunteers in 140 rural locations across six northwestern states. Inland Northwest Health Services delivers trainings in partnership with Spokane County EMS through the Northwest Telehealth videoconferencing network. EMS Live@Nite has allowed rural EMS workers to overcome barriers of distance, time, and cost that previously prevented them from receiving continuing education.
  • The Learning Exchange Reverse Demonstration (LERD) Model is part of the Rural Nurse Initiative Program. LERD allows rural nursing students to demonstrate their skills acquisition to instructors via telehealth. An evaluation of the model found that rural distance students showed similar learning outcomes to non-rural students. LERD also prevented rural students from incurring travel expenses and missing unnecessary work days, which occurs in nursing programs that require onsite assessments.
  • The U.S. Department of Agriculture's Distance Learning and Telemedicine (DLT) Grants provide critical funding for provider education and workforce development in rural communities. For example, the Central Michigan University College of Medicine uses DLT funding to help fund its Comprehensive Community Clerkship, which prepares medical students to work in underserved rural and urban areas. Students use telehealth technology to receive instruction, share clinical experiences, and connect with their peers.
  • The Healthy Eating Active Living TeleHealth Community of Practice (HEALTH-COP) program offered a virtual learning network to rural providers seeking to better manage the health of children who are obese or overweight. Providers received training via videoconferencing on counseling children and their parents about topics related to weight and nutrition. An evaluation found an increase in the number of health and wellness topics that providers discussed during visits with children, which likely contributed to improved behaviors related to eating and exercising among program participants.

Implementation Considerations

Project ECHO provides resources to support communities seeking to implement their own ECHO models. For example, the planning worksheet can help interested parties identify the key issue they want to address through ECHO and assess potential challenges to implementation. Rural communities may also benefit from reviewing successful Medicaid financing models and evaluation considerations.

Additional implementation considerations including licensing and reimbursement are discussed in Module 4: Implementation and Module 6: Sustainability.

Program Clearinghouse Examples

Resources to Learn More

Project ECHO: A Revolution in Medical Education and Care Delivery
Website
Provides information about Project ECHO, including existing teleECHO clinics, programs, and collaborations. Offers research on ECHO as a service delivery model and outreach and training events supporting the model.
Organization(s): University of New Mexico School of Medicine

Southwest Telehealth Resource Center Online Education
Website
Offers an extensive online video library highlighting training resources for telehealth program staff in six languages. Access is free after taking a short survey.
Organization(s): Southwest Telehealth Resource Center