Successful replication requires substantial training of an implementation team, and – until recently – training of “hubs” has been done exclusively by the ECHO Institute at the University of New Mexico Health Science Center. It is felt that other centers must be able to train “hubs” in order to continue the growth of the ECHO movement and accomplish our goal of touching 1 billion lives by 2025. To enable this, the concept of “superhubs” has been developed. An ECHO superhub is an organization that can train and support hubs within the ECHO model while maintaining fidelity to the ECHO model.

Guiding Principles of the ECHO Community

  1. Demonopolization (democratization) of knowledge
  2. Mutual respect and intellectual honesty
  3. Non-exclusivity
  4. Fidelity to the ECHO model
  5. Empowerment of providers to perform at their maximum capacity
  6. Primacy of human relationships/mentoring/sponsorship
  7. Commitment to listening/learning
  8. Commitment to service
  9. Positive communication, motivational interviewing and empathic skills
  10. Collective data and community-based research to improve patient outcomes

Approved ECHO Superhubs will have the capacity to:

  1. Do outreach and education on Project ECHO, with fidelity to the model and ECHO Institute-consistent messaging, including offering events such as the ECHO “Introduction” and ECHO “Orientation” to create understanding and spread of the ECHO model
  2. Recruit and engage individuals, groups and organizations that would like to implement Project ECHO to become ECHO hubs
  3. Authorize prospective replication partners by signing pre-approved partnership documents (the Intellectual Property Terms of Use Agreement and the Statement of Collaboration with Replicating Partners)
  4. Train prospective replication hub partner teams in ECHO implementation best practices and resources, in order to maintain fidelity to the ECHO model
  5. Provide access to all the ECHO resources and tools, including Box, Zoom, iECHO, ECHO Health and any others developed in the future
  6. Provide support and quality assurance of all replicating partners trained by superhubs to ensure fidelity
  7. Facilitate the sharing of resources among the MetaECHO Community
  8. Share and protect the intellectual property of the ECHO Institute and the MetaECHO Community
  9. Maintain appropriate use of ECHO logos and trademarks

Superhub Prerequisites

  1. Superhubs must have a strong relationship to the ECHO Institute
  2. Superhubs must have had experience acting as a hub, preferably for multiple conditions (exceptions may be made for organizations that facilitate the development of hubs in other ways, such as developing hub/spoke relationships for other organizations, or obtaining funding for hubs)
  3. Superhubs should be able to demonstrate financial sustainability, so that they are able to support their replication partners in the future
  4. Superhubs must demonstrate fidelity to the ECHO model and mission alignment with the principles of ECHO. These include, but are not limited to, non-exclusivity, demonopolization of knowledge, commitment to collaboration and data-sharing
  5. Superhubs must be authorized by the ECHO Institute, and have signed all superhub documents of agreement

Superhub Training Key Elements

  1. Superhub role and responsibilities
    1. Review legal documents
  2. Hub role and responsibilities
    1. Review legal documents and understand legal issues and limitations
  3. ECHO IT resources and software tools, including Box, iECHO, ECHO Health, and Zoom
  4. Fidelity principles and assessment tools
  5. Hub training skills
    1. How to mentor other organizations in implementing the culture and principles of the ECHO movement
    2. ECHO clinic facilitation and facilitation evaluation
      1. How to run a “Mock ECHO”
      2. How to teach videoconferencing (VTC) etiquette
      3. Anatomy of an ECHO
    3. Data security “best practices”
    4. Theories, approaches, and methods for evaluation and research design
    5. Curriculum development and case-presentation template design
    6. Essential teleECHO clinic roles and responsibilities
    7. Clear messaging and language-use standards when referring to the ECHO model
    8. Community participant or “spoke” recruitment, engagement and retention
  6. Fully understand and access all ECHO hub training and train-the-trainer (superhub training) resources, along with appropriate IP protections that may apply to them

ECHO Superhub Websites

  1. Superhub: American Academy of Pediatrics
  2. Superhub: ECHO India
  3. Superhub: ECHO Northern Ireland
  4. Superhub: MD Anderson
  5. Superhub: Missouri Telehealth Network
  6. Superhub: Ontario
  7. Superhub: Universidad de la Republica – Uruguay
  8. Superhub: University of Chicago
  9. Superhub: University of Wyoming