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UTAH STATE UNIVERSITY – CASEY JUDD

EHDI 2019 – TOPICAL SESSION 6, 7, & 8 – INTERNATIONAL F
MARCH 5, 2018
2:15 P.M. ET

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>> SPEAKER:  Are we ready?  All right.  I've been nursing a cold, so if I have to get a drink, that's why.  Um, welcome to the prime time time slot, the absolute best time slot of any conference, right?  That slot right after lunch, on the last day of the conference.  So, I'm glad that you're here.  Thank you for being here.  So, we're going to talk today, my name is Eric Cahill, and I'm a member of the early intervention team at the Centers for Disease Control and Prevention.  I don't know what happened there, but, okay.  Um, like I said, I'm Eric Cahill, I'm a member of the EHDI team at CDC.  I've listed my colleagues, Steve Richardson who is with us today, other colleagues, Maria Sanchez, Stephanie Henry, Ashley Satterfield‑Nash, and Kelly Dunan, we all work on this EHDI ECHO project.  Steve and I are here today.  So, thank you for being here.  Um, well, forget that.  Can we have some technical help?  Tell them it's not advancing.  Um, we have, just in the interest of time, I'll just keep talking, um, three objectives that we wanted to accomplish today.  
We want to explain the purposes and benefits of this EHDI ECHO project that we're doing, we wanted to talk about, um, identify three pieces of technology that you all would need to participate in an EHDI ECHO session, and then describe the components of a typical ECHO session.  Um, project ECHO, what that stands for, that's, um, and I actually had to put that on the first slide, because I have a terrible time remembering what the ECHO acronym, um, means, but it's the Extension for Community Healthcare Outcomes.  Um, this is a project that was started by the University of New Mexico School of Medicine.  Yeah, it's still not advancing.  Um, it was started by the University of New Mexico School of Medicine as a way to, um, what they describe as to demonopolize knowledge and amplify local capacity, provide best practice care for underserved people all over the world.  Um, the ECHO model is committed to addressing the needs of the most vulnerable populations by equipping communities with the right knowledge, at the right place, at the right time.  Yeah, it's not advancing.  The slides aren't advancing.  Um, basically, let me explain just real briefly what that is, what the University of New Mexico, um, School of Medicine did.  There we go.  Okay.  Thank you.  Maybe I hit a button.  There it goes.  Okay.  I won't touch the computer.  How's that?  So, those are our objectives.  
Um, what the University of New Mexico did, or maybe a little bit of the underlying purpose, um, that started this was, um, a physician who had a medical, particular medical specialty in Albuquerque, he was an expert in his chosen field, what he saw was he saw a lot of patients and had a lot of experience in that particular medical condition, um, he saw a need in the rural communities of New Mexico, where physicians didn't necessarily see a lot of the same condition, and so they may, perhaps didn't have as much experience in treating patients with that condition, and he started some video teleconferencing to share cases, um, to share experience, and share recommendations as a way to teach, um, the physicians and the other care providers in some of the more rural parts of New Mexico as a way to lift all.  This graphic here kind of shows, across the top, um, the specialists, you could say, in Albuquerque, um, with other physicians kind of in a learning loop, where they're sharing cases and they're learning and teaching each other, with the idea of being able to impact all of their patients, to do a better job of impacting all of their patients.  
So, that's kind of what the ECHO model is all about, is using this video teleconference technology to not just do a top‑down webinar, but to share, um, and learn from each other.  Here's kind of a picture of how they, um, University of New Mexico School of Medicine has used this ECHO model around the table.  If you think of this as a hub, um, these are the subject‑matter experts.  Um, that screen on the right is just a camera back at the, the folks around the table, and then the screen on the left is all the participants in different parts of their state.  Um, someone has, um, one of the providers on the left, um, has a case presentation that they're sharing, um, and presenting to the, um, subject‑matter experts, they're discussing the case, they're discussing kind of the ins and outs of the case and then providing some recommendations back.  Um, rather than just doing it over the phone, there's some real advantages in terms of generating better discussion when you do it, um, using that video teleconferencing aspect.  Just another graphic that they have, that the ECHO project developed, just to show that learning loop amongst the providers, um, with the idea of being able to impact the families, the patients below.  What we wanted to do at CDC in the EHDI program is could we apply this medical model, um, to the world of public health?  Could we come together, as public health programs, um, and help each other solve public health challenges, leading to improved EHDI programs and ultimately to better serve the families of children that are born deaf and hard of hearing?  
So, that's kind of where we got involved in this and trying to do this same, use this, apply this ECHO model to public health.  There's four principles, um, that the ECHO project, um, developed as kind of key; technology, sharing of best practices, doing case‑based learning, and evaluating and monitoring outcomes.  So, this is our attempt to use their model to solve public health challenges.  From a technology standpoint, um, we use Zoom software, it's similar to Skype, it's similar to Adobe or WebEx, um, Zoom is what the ECHO project uses.  It's stable, it allows for the sharing of desktops, and they have built in a lot of tools for, you know, evaluation purposes.  Um, that's what we have found, we have found that that works really well.  We send out an invitation, you don't actually have, I know, sometimes, people work in state agencies, and they have IT rules, um, you don't have to have Zoom loaded on to your system to be able to use it, when we send the invitations out to EHDI programs, um, it has a link, and you can just log‑in as a participant and, um, you don't have to download and install Zoom on to your device, um, you just need to connect it.  The video features are really, again, I'll stress that the video features are really key to, um, enhancing the discussion amongst all the participants.  
Um, you can use your computer or a laptop with a web cam, but you can also use a smartphone, you can use a tablet, um, it doesn't have to be a computer for this to work, and I know, I've used all three, and they all work equally well.  Just don't drive, if you're using your phone, at the same time.  Like I said, if you've got issues, if your agency has issues with installing Zoom, you can, like I said, you can use your smartphone, you can use your tablet, you know, some sort of other web‑enabled device.  Um, so, when we do this, we involve CDC EHDI staff, um, we try to involve a subject‑matter expert.  We've got a lot of experts around the CDC community, but we also have recognized that there are experts around the country that we, um, we try to involve as subject‑matter experts.  Um, we have someone that is willing to present their, um, if we use the medical model, present their case, um, this is public health, so we're presenting kind of those public health challenges, and then the participants, and a typical agenda, um, we try and hold these to about 60 minutes, we've toyed with the idea of maybe stretching them out just a little bit longer to 75, um, but we'll usually do an opening and introductions of, um, who we are, who our subject‑matter expert is, um, and then all the participants, so we all know, you know, who we are and what states we're all from, or what jurisdictions we're all from.  Um, we'll have arranged ahead of time for someone to present a public health challenge, or that, quote unquote, case.  
Um, there's an opportunity to ask questions back and forth from the subject‑matter expert, from those other participants.  The subject‑matter expert will offer some recommendations on, um, related, you know, kind of best practices to do, to perhaps try and solve that.  There will be an opportunity for other people amongst the other states to, and this is where you get into that aspect of learning and sharing from each other, um, you know, so not to pick on any one state, right, but state A, perhaps, has, maybe they've already cracked that challenge and figured out a way to solve it, or solved it for them, for what works for them in their state or their jurisdiction, um, and someone else, with slightly different, a slightly different setting, um, but maybe they can apply those same, um, same solutions, or modify the solutions to fit their state.  So, we make sure that there's that opportunity to share back and forth, and then our subject‑matter expert, we have them, ask them to prepare about a 10 to 15‑minute, um, presentation on best practices related to that topic at hand, and then we create time for questions and answers at the end, so that we're all able to learn.  
So, that's kind of an agenda of a typical ECHO session.  Just to show you, in October of last year, we did our first session, and it was on the topic of physician engagement.  In November, we did one on data visualization, and I'll just tell you right now, I'm going to talk a little bit more about this, but, um, from a physician engagement standpoint, um, we had Doug Ditferth from Texas EHDI program, he spoke on some of the things they've been trying to do, and Dr. Jack Lavine, he's a pediatrician in New York State, he was our subject‑matter expert.  We did data visualization in November, and Brian Shakespeare talked a little bit about their DASHboard that they've created on their website to present their data.  We had some experts from the National Center for Health Statistics in Washington, they dialed in, or connected in remotely, they offered some suggestions, and then they also taught all the participants a little bit more about data visualization.  So, those were two good sessions.  
Our next one, um, we're looking to do in April on training data reporters, seeing if there's better ways to do, to train those those people out in the hospitals and the audiologists and the intervention providers, better ways to train them how to use your EHDI information system.  We are looking to do a session on how to assess outcomes of deaf and hard of hearing children, and then some additional topics that we're looking to the future, data sharing and data linkages, um, audiology reporting, um, analysis of data, using your EHDI data, and then, you know, we're looking for additional topics.  I will tell you that, um, for those of you that were, at the beginning of our current cooperative agreement, we had a meeting in Atlanta, I guess that was probably November of 17, a lot of these topics came from those discussions that we had.  What we saw was relevant.  Training data reporters came from another recent meeting that we had last fall.  Excuse me.  So, we're trying to make sure that we have topics that are relevant to you, topics that are relevant to the challenges that you're facing.  Um, from an evaluation standpoint, our first session, as I said, was in October 2018, this was on physician engagement.  Doug Ditferth of the Texas EHDI program, he presented on that public health challenge.  Dr. Jack Lavine was a pediatrician from New York State.  This was moderated by Steve Richardson.  He did some introductions, we connected with the participants, um, Doug then presented on some of the work that they've been trying to do, some of the things that have worked, some of the things that he was still trying to figure out, there was some Q & A back and forth, some suggestions, and then we finished with, um, some suggestions and recommendations from Dr. Lavine, we finished with a quick, about roughly a 10‑minute, um, power point presentation by Dr. Lavine, and then we wrapped up the session.  
From an evaluation standpoint, I'll tell you, we had 36 participants, um, that had connected in, from 26 different jurisdictions, 13 people, excuse me, indicated that they had some increased knowledge, with 10 people indicating that they had plans to replicate a strategy that they learned that day.  Our next session was in November on the topic of data visualization.  As I said, Brian Shakespeare from Idaho, he connected in and presented on some of the work that he's been doing.  We were able to share his desktop, and he was able to show and demonstrate how his data DASHboard was working, so all the participants were able to view live his DASHboard, and he was able to demonstrate it to our subject‑matter experts.  Um, as I said, these were two folks from the National Center for Health Statistics in Washington, they were, I believe they were epidemiologists that, um, had a lot of experience in data visualization as well.  Again, Steve Richardson, um, he moderated, Brian Shakespeare presented, we had some Q & A back and forth, and then some recommendations from our subject‑matter experts.  They did a, um, a presentation on best practices, um, and then we wrapped it up.  From an evaluation standpoint, we had even more participants, 59 people connected in, from 32 different jurisdictions.  Um, 12 people indicated some increased knowledge, with 8 people indicating that they planned to replicate what they learned that day.  
Um, Maria Sanchez is another member of our team, and I don't see her, she's here this week, but I don't see her today, she's an evaluation specialist and is working closely with us to make sure that we, um, that we're evaluating the outcomes that we, to try to accomplish the goals that we've set out to do.  So, um, we have process evaluation questions that we look at, as well as outcome evaluations.  How well did we do?  How well did we, the program, do?  Did we survive?  Did we have any technical glitches?  Um, were we able to share everything as we had planned?  How many participants dialed in?  Which jurisdictions were present?  You know, how many people indicated that it was of value to them, that they learned something new?  But we also want to look at what did you learn, how have you implemented what you've learned, and how did it improve your program.  So, we'll be doing some later follow‑up evaluations, maybe to reach out to those that participated, um, at some point down the road, um, you indicated that you were going to try and implement some new things, how has that helped, so we really want to see, you know, some long‑term outcomes from this.  I wanted to show you our, the logic model that we put together, just to show you that we don't just talk about logic models, but we actually use them.  
We've made sure that we developed this so that we could, and, obviously, these are living documents, right, but, um, we wanted to make sure that we stayed focused.  Our long‑term outcomes, or the outcomes that we were hoping, to increase grantee engagement, um, we wanted to increase some of that peer‑to‑peer connection amongst the state EHDI programs, um, we wanted to support improved implementation of, um, the cooperative agreement amongst the jurisdictions, um, and we wanted to increase implementation of the best practices among the jurisdictions.  Ultimately, where that red arrow goes to is we wanted to be able to help you programs, um, improve your ability to reach the children that are born deaf and hard of hearing, reach those families that, um, which is, you know, from a big‑picture standpoint, that's why we're here, that's why we do what we do.  So, um, that's kind of the underlying basis of project ECHO from our standpoint, is helping programs to improve so that they can better reach those families.  
Just real quick in review, we wanted to explain the purpose, the benefits, of the EHDI ECHO project, we wanted to identify three pieces of technology, and we wanted to describe the components of a typical session.  Again, just as a reminder, you know, this is not a top‑down type of a thing, this is not, um, CDC speaking from on high, we envision this as the programs, um, and us learning from each other, sharing ideas and best practices together, um, so that, ultimately, we can impact families.  Um, is there any questions as we wrap‑up?  I'm going to ask Steve to come up.  He's, his specialty is in, um, communication and health education, so he's been a pretty big part of the team as well, but is there any questions you have for either of us?  She's the moderator.  Well, thank you very much.  Appreciate it.  Um, be on the lookout, we have sent out invitations in the past for the October and the November session, um, as we get closer to the April session, we'll send out those invitations with the Zoom link attached to the invitation as well.  We try and do it at a time that meets all the, reasonably meets all the disparate time zones amongst our EHDI programs, and, um, like I said, April, we're looking to do, um, how to better train data reporters, and then, um, our June session will be, um, focused on, um, using outcomes to assess progress.  Oh, we do have a question.  Wait for the mic so the CART can ‑‑
>> SPEAKER:  I might have missed it, but did you say this is only open to EHDI coordinators or to EHDI staff?  Or how are you contacting people?
>> SPEAKER:  Our principle audience is EHDI programs right now.  You know, we're trying to work with programs to help improve program development.  I don't know, Steve, if you've got a comment on that.
>> SPEAKER:  My question was just the coordinators or all staff?
>> SPEAKER:  I think we could open that to all staff.
>> SPEAKER:  In fact, there have been people there, not coordinators, that the coordinators have invited to come in and listen to this, because they're going to use it as a team, so it makes sense, to have other people there too.
>> SPEAKER:  Yeah.  Yeah, we're not, yeah, just one invitation, you can share that amongst your staff.  Very much so.  Any other questions?  In the back?
>> SPEAKER:  Hi, Eric.  My name is Jake.  I'm mainly based on the island territories in the middle of the Pacific Ocean.  We used a lot of the ECHO right now.
>> SPEAKER:  Oh, good.
>> SPEAKER:  Same activities.  Now, I think the main problem that we usually experience is that, because of the time difference, we are 18 hours ahead U.S. mainland, so is there a possibility of having it recorded, so that we can view it at a later time?  Because, usually, it's going to come out, like, early morning in that part of the area that we are currently based.  So, is this, is there any other possibility, like, it can be recorded, so that we can view it later on?
>> SPEAKER:  It is possible to record these.  Um, the one thing you would give up is, obviously, that live interaction, being able to participate and ask questions, but, yeah, it is possible to record these.  Yeah, it is possible to record them.  Um, one of the, like I said, one of the things you'd give up is that interaction, um, you know, and, maybe, this is a time to stress again, some people have been a little, somewhat reluctant to use the video capability, um, on their computer or their smart devices, some people have, you know, they have IT departments that really limit what you can and can't do with regards to, um, video, and, um, I would just say if there's a way that you can get around that, it improves the interactivity, so it's not just, yeah, it just improves the engagement amongst all those that are participating.  So, yeah, we can record these and make them available, you would just kind of lose some of that interactive nature of it, but yes.  Anything else?  Well, thank you very much. 
(Applause.) 

This is being provided in a rough-draft format. Communication Access Realtime Translation(CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.