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VA Ann Arbor Healthcare System

 

Frequently Asked Questions

What is VA SCAN-ECHO?

VA was introduced to Project ECHO in March 2010, by Dr. Sanjeev Arora, Director of Project ECHO. Specialty Care Services took interest in this program to transform the delivery of specialty care throughout VA. The ability to extend the reach of specialty services and coordinate with the Veteran’s Patient Aligned Care Team (PACT) to improve care was viewed as a great opportunity. Through a competitive application process, eleven sites have been funded to work with primary care teams since 2011. SCAN-ECHO is an approach to provide consultation and clinical support from provider to provider using VTC equipment to allow specialist teams from tertiary medical centers the opportunity to provide support to Primary Care Providers (PCP) in less complex facilities or rural areas, in which access to specialty care is not readily available. This initiative keeps the Veteran from traveling far distances, and provides PCPs instant recommendation from Specialists. It also allows for increasing provider knowledge, competencies, and professional training hours.

VA SCAN-ECHO operates like any other consultation service. First, a provider makes a formal consult request to another provider. Just like any consultation in the VA, it is processed and documented in the Computerized Patient Record System (CPRS). A consult is defined as one provider requesting another provider (often Primary Care to Specialty Care) to address a clinical problem or to answer a clinical question for a specific patient.  During the scheduled SCAN-ECHO clinic, the PCP presents the Veteran’s case using de-identified information. The Specialist, as well as other members of the SCAN-ECHO team, will deliver a treatment plan and advice to the PCP. Other PCPs and PACT members not involved in the Veteran’s care are able to listen in and participate in the discussion. During the SCAN-ECHO clinic, a didactic presentation is given discussing a topic for that specialty, which allows providers to earn CME/CEU credit. At the end of the scheduled SCAN-ECHO clinic the Specialist completes and closes out the consult in CPRS.

What are the Benefits to SCAN-ECHO?

The benefits of using SCAN-ECHO include improved quality and safety, rapid learning, and reduced variation in care. Access for rural and underserved patients is improved, thereby reducing disparities. Providers will benefit from improved professional satisfaction and interaction, and retention may be observed. SCAN-ECHO also supports the PACT model and integrates public health into the treatment paradigm. It is expected that through the use of virtual mentoring and didactic presentation, the requesting provider will be able to manage these types of cases over time as skills and knowledge is improved. This method of consultation also supports Veteran-centric care as SCAN-ECHO can be utilized to assist in providing care for Veterans living in rural areas from specialists by reducing the burden of travel to the Veteran, and reducing overall travel and fee-basis costs.

Is SCAN-ECHO considered a form of Telehealth?

No. SCAN-ECHO is not considered a form of Telehealth. The reason for this is that premise of SCAN-ECHO does not meet the definition of Telehealth as defined by Centers for Medicaid & Medicare. Although video teleconferencing equipment is used, and resources may be shared, patients do not participate and it is therefore not Clinical Video Telehealth (CVT). CVT is defined as the use of real-time interactive video conferencing to treat and provide care to a patient remotely. CVT links the patient (either at the CBOC or at home) with the provider. It is important to remember that to be considered a form of Telehealth the patient needs to be on the other end of the equipment. 

What are the intended outcomes?

The intended outcomes and goals of implementing SCAN-ECHO is to improve access to specialists; reduce fee and travel costs; improve Veteran and Provider satisfaction by delivering care in patients’ communities and increase provider knowledge through case based learning. Over time, the PCP and team will increase their knowledge base so that they will be able to treat patients with complex/chronic conditional locally instead of referring the patient in or feeing the service out. This allows patients to receive additional care from home primary care teams in their communities and enhances the ongoing relationship primary care teams have with Specialists.

What specialties are included in the SCAN-ECHO consultations?

Sites offer different specialty consultations based on population demands and the needs of primary care teams. Currently sites are providing consultations for: Cardiology, Diabetes, Endocrine, Hepatitis C, Liver Disease, Nephrology, Pain Management, and Vascular Medicine and Human Immunodeficiency Virus. The aforementioned listing of specialty services is not inclusive and continues to evolve as local needs of veterans are addressed. 

Who can I contact if I want more information on VA’s SCAN-ECHO program?

Please send all questions and/or comments to vhaosct@va.gov.

SCAN-ECHO Links