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Military Health System

Telementoring Opens Virtual Doors to Provider Learning, Expert Support

Image of A group of people meet in a room. Staff from the Madigan Interdisciplinary Pain Management Center in Tacoma, Washington, participate in an ECHO telementoring session among pain managers and specialists in October 2022. The ECHO Pain Program is a video conference mentoring program that allows health care providers to learn from each other about pain management, as well as a tool for patients to connect to their care team. (Photo: Alexe Bellingham, Madigan Interdisciplinary Pain Management Center)

A unique video conference mentoring program allows health care providers to connect, learn from, and support one another about pain management.

In turn, they improve their skills to better support their patients, upholding the Defense Health Agency’s mission to ensure a medically ready force and ready medical force.

In addition to a variety of virtual telehealth options, DHA offers telementoring options designed to connect patient care teams with specialists.

That model allows for care teams to interact directly with subject matter experts for advice, guidance, and support from expert teams, or to leverage their learning opportunities and grow professionally.

ECHO Program for Pain

The ECHO Program for Pain is one example of a DHA telementoring program.

Short for the Extension for Community Health Care Outcomes, ECHO is an educational program the University of New Mexico developed in 2003 to expand access to pain specialty care. Since then, it has been replicated at other entities globally, including DHA.

DHA’s ECHO Program for Pain intends “to bring subject matter experts and health care providers together via videoconferencing to learn and share knowledge,” said U.S. Air Force Lt. Col. Jennifer Varney, DHA’s chief of the Pain Management Clinical Support Service.

It “uses a ‘hub-and-spoke’ model with eight hubs located at strategic interdisciplinary pain clinics across the Military Health System,” she added, referencing a process that resembles a bicycle wheel, with a hub serving as the central location and spokes representing telementoring connections to providers.

Varney explained that each hub at DHA’s ECHO Program for Pain comprises specialty providers available for consultation and to conduct learning sessions with providers from the spokes, which could comprise any military hospitals or clinics, at least once a week.

“Health care providers—including primary care managers, physical therapists, nurse case managers, and others from the spokes—can utilize the ECHO hub sessions convenient for them,” she said. “The sessions allow for the subject matter experts to provide a continuing medical education learning activity as well as a case study of a patient who may benefit from the interdisciplinary presentation.”

Varney added that the ECHO program is a core component of the Stepped Care Model for Pain Management that Patient Centered Medical Home teams use. The model uses evidence-based treatments to manage pain, seeking to prevent acute pain from becoming chronic.

ECHO aims to help treat or provide information and support for “any chronic pain condition in which the primary care manager or health care team may need assistance to treat,” said Varney.

How Does ECHO Work?

ECHO exemplifies the hub-and-spoke model by having the care teams at a local military hospital or clinic present a patient case they need assistance with at the specialist hub, explained Varney.

“They reach out to their clinic’s primary care pain champion to get on the schedule for the next ECHO session,” she said.

Then, the provider presents the case to the subject matter experts for guidance on how to manage the case.

Varney underscored that providers remove all patient-identifying information for security prior to presenting the case.

How Does ECHO Benefit Beneficiaries?

While patients themselves cannot be referred to the ECHO program, patients’ health care teams can refer or present their cases, said Varney.

Yet, if a patient feels that they would benefit from their provider presenting their case at an ECHO session, they can request that, she added.

This can directly benefit beneficiaries by integrating care between the pain specialists and the therapeutic arm of the MHS.

DHA uses “technology to develop knowledge networks in which pain specialists and primary care managers co-manage patients,” Varney said.

This way, ECHO helps improve the health of service members, retirees, and other beneficiaries.

“The ECHO sessions enhance the primary care managers’ knowledge and self-efficacy for managing chronic complex pain,” she added.

Telementoring options like ECHO are especially significant for beneficiaries and providers in remote areas, where a referral to a pain specialist may be delayed or not possible.

It “offers timely case-specific knowledge and opportunities for learning and promotion of best practices,” underscored Varney.

For more information on DHA’s telementoring ECHO Program for Pain, talk to your primary care manager.

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Last Updated: October 28, 2022
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