Rural Telehealth:
Another Broadband Conversation

We have discussed the importance of reliable Internet for rural telehealth and telemedicine.  Senate Bill 2873, the Expanding Connectivity for Health Outcomes (ECHO) Act further emphasizes the significance of reliable Internet.

On November 28 the Senate overwhelmingly passed the bill that aims to better integrate the Project ECHO model into health systems across the country. Subsequently, the House also passed the legislation, which is now in the hands of President Obama waiting for a signature.

Project ECHO is a rural telehealth initiative founded by  Sanjeev Arora, M.D. in 2003.   Dr. Arora, a liver disease doctor in Albuquerque, New Mexico, was frustrated by the lack of available treatment of Hepatitis C in rural New Mexico.  Project ECHO was his way to address the problem.


Photo by Bluegrass Annie via Flickr

The ECHO model is essentially a series of hubs where groups of medical professionals come together and conduct video conferences to which rural doctors can join and collaborate on specific medical cases.  Senator Angus King was a strong supporter of the bill because of the healthcare challenges that rural communities face.  The Senator’s office states that despite the fact that nearly one fourth of America’s population lives in rural areas, only about 10 percent of physicians are estimated to practice in those areas. Geography creates a disconnect between rural doctors and the peer groups that they might collaborate within more populated areas and can limit access to specialized healthcare in rural areas.  With an Internet connection, the ECHO Model provides a conduit for collaboration that gives rural primary care professionals the tools they need to offer more specialized treatment.

In Maine, Quality Counts participates in Project ECHO at a bi-weekly Chronic Pain Collaborative that consists of a 2-hour web-based conference on pain management techniques. The hub that Quality Counts participates with is at the Weitzman Institute in Middletown, Connecticut.  To date, there are no hubs in Maine, but that may soon change if a grant application, through Health Resources Services Administration’s (HRSA) Rural Network Development Grant program submitted by Quality Counts is approved.

The grant application, although submitted by Quality Counts, was a joint effort that included collaboration with the Northeast Telehealth Resource Center (NETRC) among others.  If the grant is approved, Maine Quality Counts,will develop and implement the first regional ECHO hub in collaboration partners in Maine, New Hampshire, and Vermont.  The proposed Northern New England ECHO CARES program would create a “network of networks” in which the ECHO medical education model would be coordinated and carried out by partners across ME, NH and VT.

Even with the grant, there are 2 primary challenges facing ECHO and telehealth in Maine and other rural areas:

Telehealth Staffing
Developing and sustaining the medical professionals to participate in the scheduled videoconferences is the primary challenge with medical professionals in short supply.  Where primary care physicians are concerned, Maine ranks 40th among the 58 US states and territories for meeting the population’s need.

Telehealth Connectivity
None of this would be possible without a reliable Internet connection; even though the ECHO Model of videoconferencing isn’t nearly as bandwidth-intensive ad doctor-to-patient telemedicine and monitoring, it STILL requires a connection of about 1 Mbps symmetrical bandwidth in addition to any other Internet related activities.  The rural physicians who would benefit from the service must have the connectivity to take advantage of the program.

Senate Bill 2873 and the continued legislative support of Project ECHO solves part of the rural healthcare challenge, by providing resources for rural physicians.  Funding, to the ConnectME Authority in Maine, the New England Telehealth Consortium and other entities that administer grants for broadband deployment and infrastructure in rural areas, is the other part of the equation that ensures that those rural health care providers have the connectivity to take advantage of Project ECHO resources.