Meta Care

Jul 18, 2012, 4:30 PM, Posted by Nancy Barrand

Nancy Barrand B&W close Nancy Barrand

“You need a logarithmic methodology to expand capacity to match the logarithmic increase in knowledge that is occurring worldwide.”

That’s how Dr. Sanjeev Arora described the force multiplication theory at the core of Project ECHO during last week’s launch of the ECHO model throughout the VA. It’s also a call to action for how we approach medical training and health care delivery.

Knowledge is power, yes, but in health care, knowledge is life-saving. Knowledge is more pain-free hours in the day. Knowledge is quality of life.

We need to think differently about how we share knowledge.

Let’s allow Dr. Arora to walk us through the math:

"More knowledge has been created in the last 100 years than was created in the last 5,000. And more knowledge will be created in the next 50 years than has ever occurred before. So what this leads to is a very complex issue—you have an explosion of best practices and how do you take these best practices to affect underserved populations that may be living all over the world? As a result of this knowledge explosion, what is happening is there is a shortage of highly specialized expertise all over the world, not just rural areas; even urban underserved areas experience this shortage."

He’s right. What physician can be expected to keep up with the volume of medical literature being published? Yet people are suffering every day because knowledge and best practices that exist and are easily shared don’t reach them.

We need to think differently about how we share knowledge.

So, how do we meet this call to action? Dr. Arora is offering us a path forward. The problem isn’t that knowledge is being held for power, or that expertise capacity has reached its limits. The problem is that the conduits for sharing are too narrow. Or, to be more accurate, we haven’t hooked the pipes up to the faucets.

Project ECHO is a revolutionary model of knowledge-sharing brought about by a confluence of available technology, a passionate, caring soul, and a moral imperative: No one should die for lack of knowledge. The ECHO model uses technology to leverage scarce expertise that exists primarily in places like academic medical centers and shares that specialized knowledge and suite of best practices with primary care physicians and their teams through virtual case-based learning and mentorship; this sharing creates what  Dr. Arora calls a community of practice—a knowledge network of specialists, primary care physicians, nurses, and other care team members, all focused on the same issue and all learning from each other. (Learn more about how ECHO works.)

And, while you are sharing knowledge, it turns out you are also creating knowledge. These communities of practice become two-way knowledge streets—very early on, best practices emerge from the front lines, as they often do. Only now the pipes are in place, the faucets are turned on, and once best practices start emerging, Dr. Arora points out, they “flow back to the medical center, plus they flow to each other, so you are continuously improving process with new knowledge being generated in the field.”

Let’s get back to the math. “Force multiplication—we’ve defined [it] as a logarithmic expansion of capacity to deliver complex care—10 times or greater. That’s the kind of expertise expansion that is needed.”

Better care for more people.

Imagine where we’ll be when we globalize these networks of knowledge—when all the hepatitis C ECHO clinics are connected around the world and all the diabetes ECHO clinics are one connected community of practice.

Meta ECHO. Meta Care.

This commentary originally appeared on the RWJF Pioneering Ideas blog.