Clinical Case Report

Dermatology ECHO – an innovative solution to address limited access to dermatology expertise


Hal Lewis1 BS, Medical Student

name here
Mirna Becevic2
PhD, Assistant Research Professor *

Danny Myers3 MHA, Associate Director

Dyann Helming4 MSN, Advanced Practice Nurse

Rachel Mutrux5 BA, Senior Director

David A Fleming6 MD, Professor Emeritus of Medicine, Co-Director

Karen E Edison7 MD, Professor and Chair


1, 2, 3, 4, 5, 6, 7 University of Missouri, Columbia, MO 65211, USA

ACCEPTED: 19 June 2017

early abstract:

Introduction: Current maldistribution of dermatologists in United States (US) may make it difficult for patients to access timely and quality care. Access to specialty care may be even more challenging for rural and underserved patients due to geographical limitations and other socio-economic hardships. With over one third of primary care patients seeking care for at least one skin problem, it is important to follow the American Academy of Dermatology Special Positioning Workgroup's core areas of impact regarding treatment of conditions that affect millions of patients by using team-based approach and telemedicine technologies.
Objective: To demonstrate Dermatology ECHO (Extension
for Community Healthcare Outcomes) project approach in multidisciplinary tele-mentoring and education of primary care providers (PCPs) in treatment and management of complex, costly, and common skin diseases via live interactive video technologies.
Materials and Methods: Dermatology ECHO is a distance
education tele-mentoring platform that uses multidisciplinary case-based approach in a non-judgmental environment. A team of specialists, including general dermatologists, pediatric dermatologists, a dermatopathologist, a clinical psychologist, and a nurse practitioner, meets via video with a number of PCPs from isolated, rural, or underserved areas to discuss de-identified patient cases and present dermatology-specific continuing medical education (CME)-approved didactic presentations. The University of Missouri (MU), Department of Dermatology, leads the first Dermatology ECHO in the US. They partner with various primary care clinics across Missouri to provide mentoring in treatment of skin conditions. Missouri Telehealth Network (MTN) provides operational support through the Show-Me ECHO project. The MTN also assists with provider recruitment activities.
Results: We described a patient case to illustrate the effect of ECHO on provider distance learning and patient outcomes. A 69-year-old patient from rural Missouri was spurred by a rooster. She presented to her primary care clinic six times over a two month period. She was prescribed several different medications and underwent tests and one procedure, including vaccination. After patient's case was presented during Dermatology ECHO session, she was correctly diagnosed with a mycobacterium skin infection, and new recommendations were made. The patient improved significantly within 2 weeks.
Conclusion: As specialty medical evidence-based recommendations continue to increase, providers practicing in isolated rural and underserved areas may find it challenging to keep up with the new knowledge. Dermatology ECHO creates a community of practice that allows participating providers to discuss complex cases, receive specific guidance and mentoring, and participate in CME presentations. We presented a case which supports our observations that Dermatology ECHO is an appropriate platform for learning evidence-based medical knowledge via video-conferencing technology.