## 3 Method
### Setup
For documentation thoroughness and simplicity, the first question on the referral screen asks \"Does the patient consent to this SCAN-ECHO consult (Y/N)?\" When considering the design of the referral screen, our clinicians reported that consult screens that demand entering multiple data fields tend to reduce the likelihood of such consults being completed and submitted. As such, we deliberately designed the SCAN-ECHO consult request screen to be brief, but specific, requiring only two entries: (1) the patient ID; and (2) the clinical question. We programmed the referral screen to automatically fill-in the referring provider's name, date and time of the referral. Upon receipt of this referral, the designated specialty physician could read the clinical question that was submitted and access the patient's full medical records to gather comprehensive details regarding the patient's case and formulate a cogent care plan. Additionally, the specialist can ask further questions of the referring provider during the SCAN-ECHO session, in order to better focus the clinical recommendation(s). Educational media: We initially began with one SCAN-ECHO specialty service: pain management. Prior to the launch, we reasoned that since this service involves professional consultations without the patient present, the sessions would be most productive if the referring provider were armed with highly detailed information regarding the nature of the patient's condition in anticipation of the specialist's diagnostic questions. To address this need, the project manager coordinated with the clinicians on the team to produce a series of pain diagnostic tutorial videos, providing instructions for carrying out comprehensive examinations of the five most common pain regions: hip, knee, shoulder, back and neck. These training videos were produced in a professional studio and distributed to participating providers on a disc; we also posted these tutorial videos on-line to facilitate further access. Satisfaction surveys: We developed and implemented two on-line satisfaction surveys, which were sent at the conclusion of each session: A link to the Attendee Satisfaction Survey is emailed to all attendees to solicit their opinions about the overall session; a second email with a link to the Consult Satisfaction Survey is sent (only) to providers who processed a case in the session, to assess the utility of the specialty clinical consultation. For convenience, the surveys primarily consist of quick response type questions (e.g., checkboxes, Likert scales), along with some questions involving textual responses. This survey can be completed in 1 to 3 min (see the Results Section). Website: The project manager assembled a website for the SCAN-ECHO Pain Management service, providing a description of the specialty clinic, instructions for submitting consultation requests, videoconference session schedule, names and photographs of each specialty team members with corresponding links to their email and an up-to-date resource library containing a variety of downloadable properties (e.g., clinical guidelines, policies, diagnostic protocols, treatment algorithms, didactic PowerPoint in-services associated with each session and case summaries with treatment recommendations). Marketing: The project manager assembled a social marketing/provider activation plan, which involved identifying and recruiting local site champions at each CBOC and scheduling an in-person site visit to introduce clinicians to the SCAN-ECHO service. These presentations were made during the regularly-scheduled administrative staff meeting time(s) at each site, so as not to disrupt regular clinical operations.