Collaborative health systems ECHO: The use of a tele-education platform to facilitate communication and collaboration with recipients of state targeted response funds in Pennsylvania

Figures & data

Table 1. PACMAT demographics.

PACMAT	Academic Affiliation	Uniform EHR	Number of Hubs	Number of spokes	Number of providers	Number of patients treated total
Wellspan	No	No	1	23	30	633
Penn State	Yes	No	1	12	30	1920
UPMC Health Plan	No	No	4	32	282	2425
UPMC Pinnacle	Yes	No	1	8	10	576
Temple University	Yes	No	1	10	33	627
Geisinger	Yes	Yes	4	10	26	2574
Allegheny Health Network	No	No	1	8	18	554
The Wright Center	Yes	No	1	9	24	609
		Total	14	112	453	9918

Figure 1. PACMAT catchment areas by County.

Table 2. CHS ECHO impact on motivation, knowledge, and confidence.

Findings on CHS ECHO Impact	Key Informant Quotations
Discussions occurring during CHS ECHO bolstered motivation and confidence of PACMAT leads.	“Just knowing the fact that everyone [was] working hard to find solutions to the same issues gave me the boost I needed to energize our site-specific solutions.” (Participant 5)
	“Knowing that we all [had] this common goal to develop and make our MAT statewide platform bigger, better, and more productive validated that we [were] all trying to move in the same direction. It [was] very empowering and motivating to know [we were] not the only one trying to make a change.” (Participant 7)
	“Listening to everyone and what they [were] doing within their own practices or within their own systems was [a] high level discussion. [Made] you think and want to change things within your own system and to hear what others [were] doing as well.” (Participant 1)
A critical component of the collaborative peer learning support network of CHS ECHO was a shared trust and vulnerability that facilitated open conversations and systems level information sharing.	“The first time someone expresse[d] a vulnerability and you [could] see that it [was] well-received and other people echo that, it normalize[d] it. I think a lot of times, as leaders we feel like when we’re talking with external partners, we have to tread lightly about our opportunities for improvement and our friction points. When we felt like we could all trust each other and started having an honest conversation, I think that’s where a lot of the power came from. Instead of focusing on all the little things that we’re doing great and then stopping, it’s like oh, and we also have all these challenges. We’re hoping you guys can help us figure this out.” (Participant 4)
	“It’s just a different dynamic that's established in the two different meetings [CHS ECHO vs state quarterly meetings]. [In the] quarterly meeting, most of what we're sharing with each other [is] our successes, and there's very little dialogue about challenges and friction points. I think part of the reason is that there's folks from the state and folks are worried about their image and also worried about the fact that we apply for grants from the folks on the phone or in person. And so, when you take that out of the equation, and it's a lot of folks who are in the similar positions for their health systems, with the same grant, essentially talking about how they're dealing with that same grant, and there's no one who they perceive to be higher than them on the power structure. I think that allows for that kind of constructive and vulnerable dialogue.” (Participant 7)

Table 3. CHS ECHO themes for future collaborative opioid crisis efforts.

Findings on Themes for Future Collaborative Opioid Crisis Efforts	Key Informant Quotations
CHS ECHO discussions revealed a critical need for strategic and proactive program design and reevaluation as health systems rapidly implement opioid crisis efforts. As addiction medicine service lines continue to quickly expand, the collaborative environment created by CHS ECHO helped PACMAT leads identify important opportunities to improve data management and reporting, provision of provider support, and systems capacity building.	“My major takeaway from PACMAT is that […] the majority of other organizations were doing what we did—which is rolling out this system fix that was based on iterative improvement enhancements—without a big vision strategy of, what are we trying to design yet, particularly with the absence of data. We all really needed to kind of step back and say, what is our narrative and story to date of our accomplishments and to be able to tell that story, not only as individual systems, but also as a state.” (Participant 7)
	“One of the things that was really helpful in giving that presentation was recognizing the difficulties in gathering all the data. As we were building, because we really only started doing this addiction work at the system level about three years ago, […] there were different folks doing different things in different places. And sometimes the data just couldn't match up and there was missing data. It really helped inform us about how important it was to get that [process] shored up before we moved on.” (Participant 2)
	“As we continue to recruit [providers] through the new PACMAT and SAMHSA grant and expand our tentacles here from our hub, there's still a lot of fear from primary care doctors and hospitalists about treating them [people with OUD]. [We need] to draw on our resources here with that goal, in our experience with that goal, and explain to doctors that they're not alone in their fear. We recruited 30 practices for PACMAT and 10 of them said, yeah, we'll do it and then they realize how much work goes into it and they say, now we want to and then the other 10 were too afraid to bring on this population that they didn't think existed. For us, as a recruitment tool, it [CHS ECHO] helps us share that there’s other people all across the state that are facing the exact same issues that we are talking about.” (Participant 1)
	“Another thing that’s been really helpful is that we actually really liked the format. We really enjoyed participating in the ECHO. We realized that that was a really good way to connect people [because] a lot of the work that we do can be very isolating. So, I’m just thinking about some of our primary care doctors who service folks and maybe they’re the only people in their practice doing this work. There’s no one that they can really talk to an outpatient which can be isolating in itself. And so, we are thinking about ways to connect our spokes more frequently, so that they can feel less isolated—we realized that this needed to be a priority.” (Participant 4)
CHS ECHO models a productive collaborative peer learning network that remains sustainable as grant funding shifts. Although not a replacement for in-person interactions, CHS ECHO expands opportunities for regular, structured, and constructive dialogue to more collaborators across the state.	“I think traditionally for [a PACMAT hub] peer learning networks are very significant vehicles for our organizational development, learning and progress. Robert Wood Johnson, HRSA collaboratives, we really learn in that space. In the past we were very dependent on onsite coaching for collaborative learning, but I think ECHO makes you realize it can be more virtual than you imagine.” (Participant 7)
	“It [CHS ECHO] was an added, amplified peer learning support network [beyond] what happens at PACMAT meetings with [Secretary Levine]. We tend to think the state needs to convene these, but we could probably be independently hosting those learning networks if we have the enabling technology to be less dependent on the state. I think that is important because when the grant ends, their funding to provide that neutral platform ends. There is a shift in my thinking—now we are responsible to continue that network and not be so dependent on the state that started it.” (Participant 7)
	“We found this timeframe and occurrence to be convenient to our staff. It allowed for sharing of experiences without the necessity of travel. It offers a different aspect of engagement than in person meetings, but still a useful one. We would still not advocate for elimination of in person meetings, but the [CHS ECHO] can reduce the need for regular travel and the associated time/costs.” (Participant 2)

Table 4. CHS ECHO impact on collaboration.

Findings on CHS ECHO Impact	Key Informant Quotations
CHS ECHO brought together a variety of professional perspectives on the opioid crisis, allowing PACMAT leads to design innovative site-specific solutions with proactive consideration of collaborative opportunities at different levels of service provision and health administration.	“In their different roles, different responsibilities within their organizations, […] this isn’t just a top down approach or even a bottom up approach. [This is] people from all levels (and not just levels of care, but levels of creating access to care and coordination of care and delivery of care). It’s been motivating, but also given us an opportunity to learn about the different challenges or barriers that we might experience with different levels of service providers or different levels of administration.” (Participant 3)
	“Having access to all those different perspectives has really helped keep the conversation going – helping us to plan and anticipate challenges or barriers we might have before they come so that we can get patient feedback earlier in the process or make sure that all these people are involved in the decision making process or conversations around MAT. Knowing that all these people have some role has helped us to shape the implementation.” (Participant 6)
CHS ECHO jumpstarted more effective collaboration with external partners across the PACMAT network that sustained outside of in-person quarterly meetings with the state or CHS ECHO sessions.	“They know who you are when you're writing them and you know who they are when they're writing you and it's just easier—it facilitates that process.” (Participant 2)
	“The CHS ECHO was helpful in increasing contact with our peers who are doing similar work across the state and to generate new contacts to reach out regarding a variety of issues, including policies, strategies, billing/reimbursements, shared interests, etc.” (Participant 1)
	“We learned a lot about how other systems were managing their data, tracking either internally or using external tech vendors. We were really impressed with [one PACMAT program] […] and how they approached their registry management, data reporting, and software technology. We are working collaboratively with [her] through follow-up to bring it into our opioid dashboard reporting.” (Participant 3)
	“If it wasn’t for CHS ECHO and PACMAT, we wouldn’t even know where the other colleagues are—we all have become very close.” (Participant 3)
	“I've reached out to [another PACMAT lead] a few times […] [it] just really helps [to] strengthen that relationship within you know, when you hear that someone else is doing something neat and you want to get there because we have this relationship that's formed.” (Participant 5)
	“Being able to go to some of these other conferences or statewide convenings, or even national events and knowing other people that are in this space doing the work alongside you, and you have that person that you can sit next to, or you can follow up afterwards and say, what did you think about this? Or, that's something that we talked about in the PACMAT. I think that's been helpful just to have that connection with other people doing the work that you know they’re out there. Before the opportunity to talk to them and collaborate with them and work with them hadn't existed” (Participant 3)

Explanatory Legend.

Project ECHO: Project Extension for Community Healthcare Outcomes.

CHS ECHO: Collaborative Health Systems Extension for Community Healthcare Outcomes.

PACMAT: Pennsylvania Coordinated Medication Assisted Treatment.

EHR: Electronic Health Record.