Project ECHO is an innovative healthcare delivery solution pioneered in New Mexico by Dr. Sanjeev Arora and has now been replicated by over 150 sites worldwide. The University of Nevada, Reno School of Medicine was early to adopt Project ECHO, with only Washington, and urban Chicago replicating sooner. ECHO is a simple telehealth linkage connecting university-based faculty specialists to primary care providers in rural and under-served areas to extend specialty care to patients with chronic, costly, and complex medical illnesses.