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Truman the Tiger reaches his stethoscope through digital toolsFebruary 25, 2020

We are building the future of health care in Missouri and embracing technology that connects beyond campus to improve lives. The NextGen Precision Health Institute will link rural clinics with experts from around the world. These partnerships will revolutionize how we serve our state —but they are just the latest way we are making excellent care accessible to everyone. Our community also uses teleconferencing to support medical professionals and social media for mental health outreach. All of these resources help Missourians and bring more value to society.

Join Chancellor Cartwright for this week’s Inside Mizzou podcast. He talks with Dr. Karen Edison, who is professor emerita of dermatology and senior medical director of the Missouri Telehealth Network and Show-Me Extension for Community Healthcare Outcomes (Show-Me ECHO); and Kelli Buchanan, who is a master’s student in public health. Together, we discuss how our faculty, staff and students use MU innovations to create a healthier world.

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Moderator: [00:00:11] From the classroom to the cornfield, journalism to SEC athletics, the University of Missouri works 52 weeks a year, every year. This is Inside Mizzou — real stories, real discoveries and real impact of the Mizzou community. Today’s episode is called, “Boundless Health Care.” Ninety-nine of Missouri’s 101 rural counties have been designated Health Professional Shortage Areas. For both patients and health care providers, this can mean that critical resources are difficult to come by or in some cases totally inaccessible. Motivated by our mission to serve the state and its residents, the Mizzou community is rising to the challenge and tackling this critical problem head-on. Using an array of digital tools from social media to teleconferencing, our guests today are applying new technologies to help close the urban-rural health care gap. In the process, they’re also bringing lifesaving resources from our campus in Columbia to those who need them, no matter where they live — in Missouri or around the world. Joining Chancellor Cartwright to talk about their work are Dr. Karen Edison, professor emerita of dermatology, the senior medical director of Missouri Telehealth Network, and Show-Me Extension for Community Health Care Outcomes, or Show-Me ECHO and the senior medical director for the Missouri Center for Health Policy. And also Kelli Buchanan, a master’s student in public health. Thank you all for being here.

Everyone: [00:01:33] Thank you.

Moderator: [00:01:34] So a question for Dr. Edison, can you tell us a bit about Show-Me ECHO and how it is revolutionizing health care across Missouri?

Dr. Karen Edison: [00:01:42] I’m excited to do so. ECHO stands for Extension for Health Care Outcomes. It is a mission-based program that was the brainchild of Dr. Sanjeev Arora, who is a hepatologist or liver specialist in New Mexico at Albuquerque. And about 15 years ago, he noticed that people were dying all over New Mexico because they had hepatitis C infections in their livers and they weren’t treated. And so they would get liver cancer and liver failure and die unnecessarily. He had a 10 month wait to get in to see him at the university there in Albuquerque. And there are only two fellowship-trained hepatologist in the whole state. So he went around the state and ask all these other primary care providers, “who would like to treat hepatitis C?” And about 30 people raised their hand. And so he went to the Native American reservations. He went to the prisons. He went all over the state to the rural areas. And he now has a two hour echo clinic. Most of our ECHO clinics are one hour or one in half. But every ECHO clinic has a multi-disciplinary team. So he has a pharmacist, a psychiatrist, a social worker and a nurse. And the primary care providers around the state call in using video conferencing. So you can call in on your iPad or your laptop or your desktop and the power of ECHO — that conference — is not in the, it’s not a typical educational conference. So we start by doing a short didactic or little lecture just on something they really need to know. But we spend the bulk of the time talking through the art and science of managing the patient cases that the primary care participants have sent us in ahead of time. So it’s a case-based learning collaborative and that’s the real magic. You know, when in medicine we have to have continuing medical education credits all the time. And when we go to meetings and we pay money and we sit in the audience, research shows it doesn’t really change our practice. And so ECHO does change your practice because it’s a collegial, friendly, shame-free learning collaborative of folks who are interested in the same topic that you are. And so about five years ago, Rachel Mutrux, who’s the Senior Program Director of the Missouri Telehealth Network, and I were encouraged by a couple of our state representatives to learn more about ECHO. We’ve been doing telemedicine or telehealth in Missouri for 26 years. So as a dermatologist, I was seeing teledermatology patients all over the state for many, many years. And I didn’t really think anything about ECHO. I didn’t really know about it. But five years ago we went and we learned and we saw the power and the value of the model for Missouri. So about five years ago, we came back and we started chronic pain and we started autism ECHOs. Since that time, since 2014, we’ve grown to 23 ECHOs in many different specialties. And I retired actually in May of 2019, but I came back in November to help lead the Show-Me ECHO program. I’ve been medical director of Missouri Telehealth for decades, but I’m so excited about ECHO and I’m very excited to be here to talk to you about it today.

Moderator: [00:04:58] No, I can definitely tell. And I mean, Show-Me ECHO, to call it revolutionary is clearly an understatement. Chancellor Cartwright, Show-Me ECHO is designed to help rural Missourians and the health care professionals who serve them. Can you say a bit about how this relates to Mizzou’s role as the state’s flagship land-grant university?

Chancellor Cartwright: [00:05:18] Yeah, we are the University FOR Missouri. You know, we’re very interested in how we ensure that all Missourians have access to the quality health care that they deserve. When you look at what Missourians are interested in, recently Marshall Stewart, who is our Extension and Chief Engagement Officer, he actually, his team did a study of the state and the three areas that came up the most were education, health care and the economy. And anything that we can do to provide that type of health care that’s needed throughout the state, the better it is for all of us. When we think about the paradigm for the future, we want us to be the future of the land grant. Right? We are the flagship of the future. And part of that is that the paradigm of “everybody needs to come to us” is shifting. We need to be providing the expertise throughout the state, and that’s where we’re headed. If you look at all of the projects that we have going on. When you think about our investment in the NextGen Precision Health Institute, it is to provide the world-class care to Missourians that they deserve. And the way we’re going to do that is a number of those projects are going to be virtual. You can envision MRI scanners throughout the state where you don’t need the world-renowned expert locally, but rather we can run that virtually through a virtual cockpit where we have the experts that can then interact with people in the communities. That just serves people better. That’s who we are as an institution. And so that’s why we’re so interested in things like Show-Me ECHO.

Moderator: [00:07:07] Awesome. Great. Kelli, you’re doing some really innovative things with social media and access to mental health resources. Can you talk more about that and what you discovered and how you developed this unique approach?

Kelli Buchanan: [00:07:20] Yeah, absolutely. I’ve been working with a Mizzou research team that includes Namyeon Lee, she’s a PhD student in the School of Journalism, and our faculty mentor, Dr. Mansoo Yu, to examine how people communicate about mental health on Instagram, which is a social media platform that about 40 percent of American adults use right now. And we’re interested in looking at communication about mental health because of how many people deal with these types of illnesses in the US. It’s a really big public health problem. For instance, in 2017, nearly one-fifth of the adult U.S. population experienced a mental illness. This is about 20 percent of American adults or 46 million people. Another issue that our health care system is dealing with right now is the lack of people seeking treatment for their mental illness. So out of those 46 million people who reported having a mental illness in 2017, only about half of those people receive treatment for it. And so in order to start to try to address this treatment gap, our study takes a step back to look at the broader picture and ask the question, “how and why do people communicate about mental health on Instagram?” To do this, we systematically categorize posts that contain a search term “#mentalhealth.” And I think it’s important to note here that these topics are sensitive health issues to respect the privacy of people who choose to share about mental health, we only examine public post and we don’t include any specific information from the post and our research results. And we found that people who are posting about specific mental illnesses, such as an anxiety disorder, are much more likely to seek engagement from their audience than posts that don’t mention any mental health disorders. And this is important because we found that people are using Instagram in order to connect with other individuals who are having similar experiences with respect to mental health. Also, that’s so important that new health care practices are supported by evidence. And so our study provides preliminary support that we can extend established health communication theories to social media, which might in turn help providers quickly and more effectively harness the power of these platforms to extend access to important information and resources related to mental health.

Moderator: [00:09:22] And so how does it feel to be using such up-to-date technology to address such a complex issue?

Kelli Buchanan: [00:09:28] Yeah. So I think that it is important that we try to make it easier for people to seek important information. So Instagram is an application that a lot of people use on a daily basis. So if we can disseminate information in a way that makes it easier for people to access, then we can try to start to address this treatment gap.

Moderator: [00:09:52] Okay. And then a question for both of you, Dr. Edison and Kelli, both Instagram and telemedicine connect more people to more resources. How has technology further transformed your collective work in health care?

Dr. Karen Edison: [00:10:05] The technology we use in Show-Me ECHO is so easy, we just use a product called Zoom. And so it’s, even for older folks who aren’t as technologically adept, it’s very easy to use and it’s easy for a primary care folks to use. We do most of our ECHOs over the lunch hour, so they have to tweak their schedule a little bit so they can actually get there. So we tend to do that little didactic first. And so people will eat their lunch off-camera, and then we do the patient cases after that. We let people come and observe or lurk a time or two. But we really like for people to be active participants because that’s the value of the program. And they get free continuing medical education credits for doing so. So they get something out of it as well. But they also get better, what’s called self-efficacy. So they feel better about their ability to treat diseases that they weren’t treating before. And I think something Kelli said is really important, that new innovations need to have evidence behind them. And so we have a robust evaluation and research program around Show-Me ECHO and some of the things we found so far for kids with asthma over the last three years, we’re saving between two and three million dollars a year statewide with decreased hospitalizations and emergency department visits. And we know this because we have the Missouri Health Net or Missouri Medicaid data at our Center for Health Policy. So we can look at that data and see the impact of the program. We also have trained an autism specialist within 60 miles of every Missouri family now. We probably don’t have time for the whole story, but used to be there was a long wait to get kids in to be evaluated for autism so that they could be deemed appropriate for certain advanced early therapies. But now, if certain pediatricians do autism ECHO and jump through a couple other hoops, the state will say you are a diagnostician for autism. And then those families can get those diagnoses earlier and those kids can get treated earlier, which is fantastic. One more: in dermatology, which is my field, we have trained these primary care providers all over the state to look for and diagnose melanoma, particularly in high-risk patients. And they have diagnosed over a hundred melanomas that they say they wouldn’t have without derm-ECHO, which is really great because with melanoma, if you catch it early, you’ll live. And if you don’t, you die. It’s still just about that easy.

Kelli Buchanan: [00:12:40] What Dr. Edison says is incredible. And Show-Me ECHO sounds like an amazing program that’s extending health care access throughout the state, especially the rural corners that might not have, they might have to travel many, many miles to see a specialist.

Dr. Karen Edison: [00:12:56] Do you know where Eminence, Missouri is?

Kelli Buchanan: [00:12:56] Yes, I do, actually.

Dr. Karen Edison: [00:12:58] Do you? There’s a nurse practitioner, her name’s Sue Norris, in Eminence, Missouri, and she participates in four of our ECHOs. She does chronic pain, opioid use disorder, hepatitis C and dermatology. And she personally has diagnosed and cured over 100 people with hepatitis C in Eminence, Missouri.

Kelli Buchanan: [00:13:17] That’s incredible. So I think a trade off of technology is that information is so easily accessible that it’s hard to sift through all of that information, especially for consumers that might not have access to a specialized information like we do at the university. So I think those highlights the importance of making sure about high-quality evidence is available to everyone, not only people who can go to their doctor easily to make an informed choice, but also people who are underinsured, which speaks to the importance of health literacy.

Dr. Karen Edison: [00:13:51] And just what you’re saying about so much information and needing to sift through it and find out what’s evidence based and what’s important. Same thing with ECHO. We sift through all the data in a specialty and just give it to the primary care providers, just what they need to know. Because they are busy. And it is hard. Medicine changes so fast. There’s so many advances just on a daily basis and really figuring out what it is you need to know and how that needs to change your practice to deliver high-quality care for patients is a big challenge for primary care providers. And we’re trying to do what we can to help with that.

Moderator: [00:14:29] And so, for Chancellor Cartright. The work that both Kelli and Dr. Edison are doing helps us break down traditional and geographic barriers to health care. Why is it so important for Mizzou to find new ways to reach out and serve residents of Missouri and beyond?

Chancellor Cartwright: [00:14:45] When when we think about what we are as an institution, our campus is not just defined as Columbia. We have Extension offices throughout the state. So clearly we are in every county and we owe it to Missouri to deliver and to help as much as we can. It is our role as a campus. We’re also interested in innovation through collaboration. And that collaboration is not just here in Columbia, but it’s throughout the state. And being able to connect people in a way that everybody throughout the state has access to the best health care providers possible. It might be virtually, but they have access to those people. And that is what we allow through some of these programs. Show-Me ECHO, all of the work that’s being done in public health, we allow people to be able to be connected to the expertise that they deserve, and we make it much more accessible. If you think about technology, we have a partnership that we’ve had with Cerner now through the Tiger Institute for Health Innovations, that connects to some of the things Dr. Edison was talking about. How do we ensure that the right information is getting to people? If you give them everything, it’s just overwhelming. Kelli said this. It’s so much information. How do you sift through all of that information? And a large part of the scholarship right now around health care is around, how do you get the right amount of information to people? The human factors. What is it that will allow you to make the right decisions, have sufficient information and not be overwhelmed? And that’s important. That’s important so that people can can make sure that anybody we’re treating the patients are getting the best care possible. And we’re committed to that. So that’s what this is about. Right? It is it’s about, how do we serve? It’s about what we do for this state. We are, as I always say, we are not just the University of Missouri, but where the University FOR Missouri.

Moderator: [00:16:59] Definitely. And so speaking to that, how does that fit into the vision for the NextGen Precision Health Institute and how our people will be able to revolutionize health care?

Chancellor Cartwright: [00:17:11] Yeah. You know, when you think about putting together a large initiative, an initiative that is $221 million to build a building and to put the instruments inside of it, you want to ensure that everybody has access and we’re going to use the best technology possible. We’re going to make sure that all of the scholars that are associated with that are connected. We are committed to getting not just coming up with new innovations, but making sure that those innovations are disseminated throughout the state. Private-public, private partnerships where industry and others are helping us to move that information out. We’re we’re committed to the types of things that Dr. Edison talked about. If we can take what we know and work with our partners and learn from our partners, we can get the information out there that helps people to get cured. Helps people to get diagnosed earlier with melanoma. That is what we should be committed to, is how do we ensure that that gets out there as quickly as possible? And the best people are distributed throughout the state. So we don’t see it, that it’s just simply the epicentre is here in Columbia. That’s part of it. But there are remarkable people throughout the state and we should make sure everybody has access to those remarkable people.

Dr. Karen Edison: [00:18:36] And just like the Chancellor was saying in our Show-Me ECHO program, not all of our expert teams are from MU. So we have expertis, we go all over the state and find the best people where we can find them. And we have expertise from universities in St. Louis and Kansas City. We have folks from Springfield and Cape Girardeau. Our teams are virtual.

Chancellor Cartwright: [00:18:57] Yes. And that’s what we want to do. So I totally agree. Thank you for making sure people understand, we collaborate throughout and we take the best, the best people from wherever they are. And we want to make sure all of Missouri has access to those people.

Dr. Karen Edison: [00:19:11] That’s right.

Moderator: [00:19:13] So a question for everyone to kind of finalize everything. So from what we’ve discussed, the future of health care in Missouri and around the world is full of so much potential. What is one of the most exciting possibilities you see for where this journey will take us?

Kelli Buchanan: [00:19:27] Just from listening about Show-ME ECHO, I think the most exciting part of using technology as a powerful tool is reaching populations that have traditionally been underserved, that previously health care systems were neglecting just because of their geographic location.

Dr. Karen Edison: [00:19:49] Right. And tomorrow morning at 5:00 a.m., I’m going to the University of Mississippi to talk to leaders there about getting ECHO started in a robust way in that state. Folks from our team are in Alabama today doing the same thing. We are a superhub site now, meaning the University of New Mexico has deemed us, you know, a great ECHO site. So we are training other states and even other countries to do ECHO, which is really fun.

Kelli Buchanan: [00:20:16] That’s amazing.

Chancellor Cartwright: [00:20:19] When you when you think about health care, it is really what we’ve been saying and that is providing access and making sure that there’s, the disparities are significantly reduced around the state. Why are we so interested in broadband access around the state? Why is it that Marshall Stewart and his team are so committed to working with the state and working with people around the state and providing broadband, is because we see that that access is going to help us in health care. And that connection between IT and health care continues to expand. And how can we leverage that using Zoom to connect people around the state? You can only do that if you have sufficient broadband access. And so all of this comes together, and we’ll make sure that if we have that right access, then we’re going to leverage that and we’re going to connect people. And it is that connection, it’s the interconnectedness of the expertise around this state that is in the best interests of our citizens, that we continue to push for and will continue to drive and improve the health care for all Missourians.

Moderator: [00:21:29] Ok. Well, I think that’s a great place to end it. Thank you all again for being with us today. Now, there’s just one more thing to do before we leave. And why bicycles fall over?

Kelli Buchanan: [00:21:45] I don’t know why?

Moderator: [00:21:46] Because they’re two-tired.

Moderator: [00:21:47] (Laughing)

Moderator: [00:21:58] Our audio engineer is Aaron Hay. Our featured music is composed by MU master’s student Niko D. Schroeder and performed by the Donald Sinta Quartet. You can find more information about Niko, the Quartet and their piece on the Inside Mizzou webpage. Make sure to join us next time to stay on top of what’s happening at Mizzou. Thanks for joining us on this episode. See you around the Columns!