HIV ECHO Experts Address Care Concerns, Challenges, Solutions On May 27, a group of health care professionals across diverse specialties and areas of expertise gathered online with a common goal in mind — to gain knowledge about HIV care and prevention. In the Missouri Telehealth Network’s latest HIV ECHO session, attendees had an opportunity to learn about how substance use interacts with HIV-positive status. The session’s main didactic, titled “Substance Use and HIV,” was presented by Stacey Higgins, a licensed professional counselor at Washington University who works with HIV-positive youth and adolescents. Her presentation tackled several topics on HIV status and substance use: trends and red flags, treatment options and ways providers can best support patients who are dealing with these issues. “There’s kind of this thought, among so many of our youth that I’ve worked with, that HIV is the worst thing that could happen to them,” Higgins said in her presentation. “They feel like if their provider believes that as well, then the only thing that can numb it is substance usage.” Higgins emphasized that providers have a role to play in shifting patients’ mindsets. This is especially necessary given that substance abuse is frequently associated with negative outcomes for HIV patient treatment, medication adherence and disease progression. Click here to read the full story and learn more. Becevic, MTN/ECHO Lead Evaluator, Receives Ann K. Covington Award For undergraduate students, applying to nationally competitive fellowships is a rigorous process that demands perseverance, hard work and determination. The university mentors who help undergraduates through this process play a fundamental role in providing professional and academic support for student success. Mirna Becevic, PhD, assistant professor of telemedicine and lead evaluator for the Show-Me ECHO project, received the Ann K. Covington award for excellence in fellowship mentoring. The MU Fellowships Office introduced the Ann K. Covington award in 2014 as a way to recognize members of the university faculty or staff who have mentored an undergraduate applicant for at least one nationally competitive fellowship. Students who have applied for a fellowship in the past year are able to nominate a mentor for the award. Rebecca Shyu, a senior studying computer science, was Becevic’s nominator. She is an undergraduate researcher at the Missouri Telehealth Network’s Show-Me ECHO program, where she has worked with Becevic since 2018. “In the past three years, my research skill set and collaboration efforts have grown exponentially due to Dr. Becevic’s mentorship,” Shyu wrote in her nomination letter. “Her perfect balance of allowing me independence while guiding skillfully forced me to be creative and problem-solve.” Click here to read the full story and learn more. New Study: ECHO Impacts Melanoma Melanoma incidence rates are rising faster than the rates of any other malignancy. However, non-dermatologists lack training to identify high-risk patients and implement melanoma screenings. In addition, most patients from rural and underserved areas have inadequate access to specialty care, which can lead to later-stage melanomas and poor patient outcomes. A new study by the Missouri Telehealth Network and Department of Dermatology at the University of Missouri shows that ECHO can have a significant impact on identifying melanomas. Researchers helped participating primary care providers to integrate melanoma risk surveys into their regular clinics and to screen high-risk patients through ECHO sessions focused on melanomas. “During the course of the study, the primary care providers reported identifying almost 1,000 high-risk patients and detecting 36 new melanomas,” said Mirna Becevic, PhD, lead author of the study and an assistant professor of telemedicine and dermatology at MU. “In addition, we learned about facilitators and barriers of melanoma screening in primary care settings.” The study, Melanoma Extension for Community Healthcare Outcomes: A Feasibility Study of Melanoma Screening Implementation in Primary Care Settings, was funded by the Missouri Foundation for Health. MU launched the first dermatology ECHO program in the United States in 2015. Click here to learn more about MU’s ongoing Dermatology ECHO learning sessions. ECHO Research Assistant Selected to Present to Missouri Lawmakers Each year, the University of Missouri System undergoes a rigorous selection process to identify exceptional student researchers to present their projects to state lawmakers in Jefferson City. Rebecca Shyu, a University of Missouri—Columbia junior and undergraduate research assistant with the Show-Me ECHO program, was selected to present her work on rural health and tele-education in Missouri. “Currently, 37% of Missourians live in rural areas where there is a shortage of providers,” Shyu said in her presentation. “This means that access to health care is extremely difficult for rural communities, which leads to worse health outcomes.” Through her team’s research question, Shyu sought to explore the potential impact of Show-Me ECHO as a tool to educate providers about chronic conditions. The goal was to see if there was a link between providers’ participation in Show-Me ECHO sessions on chronic conditions and rural patients’ ability to access health care services for these conditions. “Our preliminary conclusions show that the Show-Me ECHO program is increasingly impacting Missourians,” Shyu said. “More providers are showing up and participating each year, leading to better quality health care in rural areas. Time, money and lives, as a result, are being saved.” Click here to learn more. MU nursing student Chelsea Howland’s dad uses telehealth to manage his diabetes. MU Study Shows Telehealth Helps Patients, But Increases Nurse Work When COVID-19 hit, University of Missouri Sinclair School of Nursing student Chelsea Howland saw firsthand how much telehealth helped her dad. He has Type 2 diabetes, lives in a rural area, and has regular telehealth visits with his diabetes specialists. Her newly published research shows that using telehealth to help patients can increase work for nurses, who are part of a nationwide health care workforce shortage. “As a nurse, I am always thinking of new and innovative ways to use technology to help people manage their chronic conditions and live a more healthy, active lifestyle,” Howland said. “As telehealth continues to become more popular, it can be used to get health behavior intervention tools to the people who need them most, but we also need to keep in mind the strain it puts on nurses that are going above and beyond to make this possible.” Nurse Howland’s goal is to improve access to chronic disease management resources to people like her dad. Her study Primary Care Clinic Nurse Activities with a Telehealth Monitoring System was recently published in the Western Journal of Nursing Research. Funding was provided by the National Institutes of Health and the Agency for Healthcare Research & Quality. Click here to learn more. MU Telehealth, Dermatology Leader Delivering AAD Named Lectureship University of Missouri telehealth and dermatology leader Karen Edison, MD, has received the Clarence S. Livingood, MD, Award and Lectureship for the American Academy of Dermatology 2021 VMX virtual conference, April 23-25. She will address the current rapid transformation in dermatology and how to successfully lead through such rapid change in her plenary lecture “Using Technology to Increase Access to Dermatology.” Edison’s presentation will reveal that two-thirds of skin disease patients in the U.S. are cared for by health care providers “without our expertise” and that “access to dermatologic expertise is limited for too many patient populations.” “We have a duty to society to extend our expertise to underserved populations, both geographic and socioeconomic,” she said. “and can use technology beyond teledermatology to do so.” Edison is the founding physician of the Missouri Telehealth Network, Show-Me ECHO program and Center for Health Policy at the MU School of Medicine. She served as Philip C. Anderson Professor and chair of MU’s Department of Dermatology before recently leaving department duties to focus on telehealth and health policy. MU Computer Science Student Shyu Selected as 2021 Goldwater Scholar University of Missouri student Rebecca Shyu, who is involved in advancing MU’s Missouri Telehealth Network and ECHO program, has been named a 2021 Goldwater Scholar. She received the award with fellow MU student Brandon Lee, who is a double major in chemical engineering and physics at MU. The College of Engineering students made MU the only school in the state with more than one Goldwater Scholar recipient. Shyu is pursuing a PhD to become a university researcher in biomedical informatics, as well as an expert on health topics and policies. “I’ve always been interested in medicine but was not sure about pursuing an MD,” she said. “Computer science provides so many interdisciplinary opportunities. I hope to use my background in computer science and data analytics to make new discoveries.” Shyu is studying health disparities using geospatial technologies with MU School of Medicine’s Department of Health Management and Informatics. She also is researching health care policy related to substance abuse using telemedicine with colleagues at Harvard Medical School. Shyu’s MU mentors include telehealth evaluation expert Mirna Becevic, PhD. Click here to learn more. Show-Me ECHO 2020 Annual Report Show-Me ECHO’s 2020 Annual Report is a detailed analysis that describes a rapid and comprehensive response to the COVID-19 pandemic and other pressing health issues for Missouri. The report shows how Show-Me ECHO, part of the Missouri Telehealth Network at the University of Missouri School of Medicine, partnered with thousands of organizations across the state and beyond to improve patient care. These collaborations expanded Show-Me ECHO’s reach to nearly every Missouri county and almost 6,000 health care providers, educators and other professionals across the state. CDC Shares Missouri COVID Insight “The success of MU Health Care’s rapid adjustment and response to the COVID-19 pandemic lies in its dedicated workforce, strong collaborative learning network, expertise in rural health, and robust telehealth infrastructure,” according to the piece published by the Centers for Disease Control and Prevention in its journal Preventing Chronic Disease. Click here to learn more. As Telehealth Grows Tremendously, Behavioral Health Stays Dominant Patients using telehealth have increased tenfold since 2010 among Missouri Medicaid users, and the vast majority of them continue to receive behavioral health services. The growth of telehealth in Missouri is attributed to state telehealth laws in 2016 and 2018 that allow any licensed or registered professional to provide telehealth services, as well as rapid improvements in telecommunications technology that became widely accepted by patients and providers. Behavioral health was among the first services provided by telehealth because videoconferencing was easily applied to conversations between patients and providers. While many other care specialties have subsequently used telehealth, behavioral health has remained dominant due in part to the need for substance abuse treatment and suicide prevention. Reference: MO HealthNet claims data accessed through the MU MO HealthNet Data Project, a collaboration of MO HealthNet, the Center for Health Policy, and the Office of Social and Economic Data Analysis at the University of Missouri. Data analyzed by project staff and the Missouri Telehealth Network. Click here for a National Public Radio story on the Missouri telehealth data. Show-Me ECHO Enhances Diagnosis of Skin Conditions A two-year study found that Show-Me ECHO’s Dermatology project provided participating primary care providers with expert recommendations that benefited nearly 84 percent of adult cases and 72 percent of pediatric cases. “This program breaks the mold,” said study co-author Jonathan Dyer, MD, professor and interim chair of dermatology at the University of Missouri School of Medicine. “These are real cases and real-life discussions. We believe this project will help doctors take the cases presented and apply them to others in their clinic. The patients will benefit from this program because they are provided the correct diagnosis at the correct time, right at the point of care, which will improve their outcome and reduce their cost and the expense incurred by the health system.” Click here to learn more. Show-Me ECHO Asthma Receives ABMS Quality Improvement Award The American Board of Medical Specialties (ABMS), the leading not-for-profit organization overseeing physician certification in the United States, awarded the University of Missouri School of Medicine’s ECHO Asthma program with the Portfolio Program Outstanding Achievement in Quality Improvement (QI) Award. The award recognizes exemplary efforts and activities to improve patient care quality, safety, outcomes and experiences. MU was selected based on the QI excellence it demonstrated in implementing the Asthma Ready® Communities (ARC)-sponsored Asthma Care Accelerator (ACA) Extension for Community Healthcare Outcomes (ECHO®) QI project, an inner-city initiative seeking to decrease the rate of uncontrolled asthma. Based on a community needs assessment of stakeholder and family focus groups, the project launched in 2018 with an in-depth understanding of contributing factors involved as well as an array of effective interventions. The project created a learning collaborative to implement asthma practice changes in alignment with national guidelines. Activities included the use of objective measures for assessing airflow and coaching patients for optimal inhalation technique, educational programs for school nurses, standardized asthma self-management education across settings, verification of dispensing rates, and electronic run charts to track practice changes. The ACA initial pilot resulted in increased use of inhaled corticosteroids with improved disease control and decreased risks. ACA is now available across the entire state of Missouri. Click here to learn more. ECHO Autism Helps Doctors Ease Patients’ Transition to Adulthood To improve access to care for teenagers and young adults with autism spectrum disorder (ASD), a researcher from the University of Missouri Show-Me ECHO program teamed up with other national experts to analyze a pilot project designed to train and mentor primary care physicians (PCPs) in best practices. The researchers discovered the project significantly improved PCPs’ confidence in caring for youth and young adults with ASD. “We know that identifying young people with autism and symptoms of autism is important because early intervention is important,” said study senior author Kristin Sohl, MD. “But as young children diagnosed with autism are aging, we’ve realized that over 500,000 with autism are turning 18 every single year. And they need ongoing medical care and support in their daily lives. Unfortunately, the health care system is not organized to support them. That’s why we devised this pilot program.” Click here to learn more. Missouri Telehealth Network 2017 Annual Report Show-Me ECHO is saving lives and money. Twenty-eight Hep C patients are being treated by a Hepatitis C ECHO participant from a remote Shannon County clinic. Asthma ECHO helped save MO HealthNet $8.3 million in the past two years.* By April 2018 every family in Missouri will be within 60 miles of an ECHO Autism-Trained Provider who can diagnose young children with obvious autism symptoms and manage their medical conditions. To read more about Show-Me ECHO’s impact click here to view the 2017 Annual Report. To view the 2018 ECHO Evaluation Report, click here. ECHO Answers Opioid ‘Emergency’ Media outlets across Missouri and neighboring states looked to Show-Me ECHO’S Opioid Use Disorder ECHO and Chronic Pain Management ECHO for information when the opioid epidemic was declared a national public health emergency. ECHO Reduces Impact of Asthma Deb Cook, RN, director of health services for public schools in Kennett, Mo., regularly participates in Show-Me ECHO’s Impact Asthma ECHO. “I can connect with several experts in the area of asthma, including a pediatric pulmonologist, a pediatric allergist and other asthma experts,” she said. ECHO Autism Featured in KRCG-TV Special Report ECHO Autism helps increase experts’ reach to providers caring for children with autism throughout the state. See the full story from KRCG-TV. Asthma Care Improved Across Missouri, Money Saved Building on the work of the MO Asthma Control Program and the Missouri Foundation for Health, Show-Me ECHO Asthma counties saw better asthma care and saved Medicaid $8.3 million over two years. See the map below of the 29 counties affected by Show-Me ECHO Asthma. DISCLAIMER: These are PRELIMINARY numbers only. More robust analyses are underway and this page will be updated when complete. Additional analyses with more rigorous methodological design are necessary to better delineate the impact of the project. Autism Care Improved, Diagnosis Time Shortened by New MU Program Wait lists for a specialist to confirm an autism diagnosis can be agonizing and last months. As the prevalence of autism and autism spectrum disorders increase, so does the demand for a health care system that is fully equipped to respond to the complex needs associated with autism. Now, Extension for Community Healthcare Outcomes (ECHO) Autism, a new program from the University of Missouri, is training primary care providers in best-practice care for autism spectrum disorders. Initial results of the pilot program found significant improvements in primary care provider confidence in screening and management of autism and in utilization of specific tools and resources. “We are very excited about the initial results from the ECHO Autism model,” said Kristin Sohl, associate professor of child health and the director of Show-Me ECHO Autism. “Children with autism can show symptoms as early as 12 months; however, in too many cases children may not receive a diagnosis until they are 5 years old. Early diagnosis is critical for children with autism, and primary care providers play an important role in that initial process.” Read the full story. Show-Me ECHO Empowers Rural Physicians to Treat Hepatitis C, Other Chronic Conditions MU telehealth initiative aims to combat rising hepatitis C infection rates According to the Missouri Department of Health and Senior Services, hepatitis C is on the rise in Missouri, and it is also being diagnosed earlier in younger individuals. Show-Me ECHO, a new telehealth training initiative from the University of Missouri School of Medicine, empowers physicians in rural parts of the state to treat the increasingly common condition. Approximately 7,200 new cases of hepatitis C were identified in Missouri in 2015, an increase of nearly 1,700 cases from 2014. Funded by the Missouri legislature, Show-Me ECHO — which stands for Extension for Community Healthcare Outcomes — allows a team of experts to use videoconferencing technology to train providers throughout the state to identify and treat chronic conditions such as hepatitis C. Read the full story.