Indian Country ECHO – Innovating Provider Education

Megan Woodbury

Project Manager

Ashley Day Navajo Nation ECHO Project Specialist

In 2003, the ECHO model, which stands for Extension for Community Healthcare Outcomes, was developed by a physician from the University of New Mexico to address an increased need for providers who could treat Hepatitis C in rural communities. In 2017, Northwest Portland Area Indian Health Board (NPAIHB) began to closely examine the ECHO model, specifically if any ECHO programs were currently owned and operated by and for the tribes. That same year, the 43 Tribes that make up the NPAIHB came together to launch Indian Country ECHO in response to the ongoing Hepatitis C crisis in our tribal communities.

From the beginning, Indian Country ECHO has aimed to bring knowledge and skills to primary care providers at I/T/U (IHS/Tribal/Urban) facilities so patients can receive the best possible care in their communities and from providers they know and trust. This approach has reduced the cost of referrals and the need for patients to travel to a facility outside their community.

Indian Country ECHO does this by providing a variety of services that include:

• Virtual ECHO Clinics – Hosting 1-hour long, regularly scheduled sessions through Zoom that allow for a friendly, interactive learning environment. Participants can connect with specialists and peers over didactic presentations, learn through presenting patient cases and/or participating in discussions about patient cases, receive up-to-date patient case treatment recommendations and best practices, receive advice from subject matter experts, and obtain free continuing education credits.

• In-Person and Virtual Training – Planning and hosting trainings based on the I/T/U facility’s subject matter requests (ex. Harm Reduction, Hepatitis C, Substance Use Disorder (SUD), etc.), to increase provider and clinic capacity to offer high-quality care.

• Technical Assistance and Capacity Building – Offering confidential services designed to help I/T/U facilities optimize clinic policies and procedures, enhance care delivery, and further build the I/T/U facility’s capacity to prevent disease and treat patients.

• Indian Country ECHO has continued to grow. Over six years later, we have expanded our initial focus on Hepatitis C to include other disease topic areas such as Cardiology, Dementia, Emergency Medicine in

• Rural and Indigenous Communities (emRIC), Infectious Disease, Journey to Health (Behavioral Health), SUD and more. We have held over 650 virtual ECHO sessions, 34 in-person and virtual trainings, served over 35,000 I/T/U providers, and provided over 1,500 patient treatment recommendations. While the ECHO programs focus on serving the Northwest Tribes,

• Indian Country ECHO has grown to serve providers throughout Indian Country.

In response to the COVID-19 pandemic, Indian Country ECHO launched the COVID-19 ECHO program in March 2020. The COVID-19 ECHOs have been led by tribal health experts such as Dr. Jorge Mera, MD, Infectious Disease Specialist, and ECHO Medical Director; Dr. Tom Becker, MD, Ph.D., Medical Epidemiologist; Whitney Essex, MSN, Family Nurse Practitioner; Brigg Reilley, MPH, Epidemiologist; Dr. Thomas Weiser, MD, Medical Epidemiologist, among many others. Their expertise and guidance have been vital in quickly and efficiently bringing the most up-to-date information on the diagnosis, prevention, and treatment of COVID-19 to tribal leaders, public health staff, clinicians, and more at a time when our knowledge of the disease was evolving daily.

With the halt to all in-person activities, Indian Country ECHO took this as an opportunity to launch our first-ever virtual provider training. This training took place on July 23rd, 2020, and focused on SUD. The goal of the training was to continue providing education and an opportunity for attendees to connect with subject matter experts, in addition to addressing the evolving opioid crisis and the rise in overdoses seen during the pandemic.

With the changing status of the pandemic, in October 2022, we held our first in-person training in almost three years. Indian Country ECHO provided a 2-day in-person training for Billings Area tribal providers in Billings, Montana that focused on what is now called “Ending the Syndemic”. “Ending the Syndemic” refers to not only the diagnosis, treatment and prevention of Hepatitis C and SUD but has also expanded to include Sexually Transmitted Infections (STIs) like Syphilis and Congenital Syphilis.

With travel restrictions now lifted, Indian Country ECHO also looks forward to hosting the upcoming Ending the Syndemic Clinical Training for our member tribes. The training will provide comprehensive information to effectively address the evolving Hepatitis C, SUD, HIV, and Sexual Transmitted Infection syndemic. This free 2-day training will be held at Ilani Resort on October 5th and 6th, 2023. To learn more about the training and register, please visit our website at: https://www.indiancountryecho.org/ets-october2023/ .

Indian Country ECHO continues to adapt and evolve to meet the needs of our member tribes, tribal organizations, and the communities they serve. We are beyond thankful for the support we have received from the Northwest Tribes and NPAIHB, without all of whom, our work would not have been possible. Indian Country ECHO looks forward to continuing our efforts to support all who serve our communities. To learn more, visit our website, IndianCountryECHO.org, or email us at echo@npaihb.org. NPAIHB’s Indian Country ECHO program is funded by the Indian Health Services and the Minority HIV/AIDS Fund.