Sanjeev Arora, a physician at the University of New Mexico and one of the few hepatitis C specialists in the state, has extended high quality medical care to New Mexico’s chronically underserved rural areas. In 2004, he created Project ECHO (Extension for Community Healthcare Outcomes), a telemedicine and distance-learning program that links doctors in rural or prison clinics to disease specialists working at the university. The program makes specialist-level care available to thousands of patients who before went untreated.
The long-distance approach is growing in popularity among health care reformers. The Sequoyah Memorial Hospital in Sallisaw, Oklahoma, for example, uses videoconferencing to connect stroke patients with a neurologist in Fort Smith, Arkansas. And through Boston’s Center for Connected Health, health workers in remote villages in Cambodia consult Harvard physicians. These developments have not escaped the notice of federal policymakers: in fact, the Obama health care law includes $1 billion a year to study and implement information-based technologies, including telemedicine.
Telemedicine could have profound implications for impoverished communities in a state like New Mexico, where 32 of the 33 counties are listed as medically underserved. One-third of the state’s population lives in rural areas, and many are poor and uninsured. Project ECHO is an attempt to correct the glaring failure to provide care for the thousands of New Mexicans living with hepatitis C, a deadly but curable disease. In 2004, only 5 percent of the roughly 30,000 New Mexicans with hepatitis C were being treated.
Using teleconferencing, phone, and e-mail, specialists at the University of New Mexico and community practitioners co-manage patients. There are now approximately 255 Project ECHO treatment sites in New Mexico, of which 21 focus on hepatitis C. None of these sites treated hepatitis C before joining the project. Community providers working with Project ECHO participate in weekly hepatitis C clinics in which they take turns presenting cases and discussing their patients’ treatment plans. A diverse group of University of New Mexico specialists sits in on the clinics, responding with questions and advice. These weekly clinics are held over videoconference.
Arora believes this hands-on, case-based approach is the best way to teach community providers to treat patients with complex diseases. A study of 14 community clinics and 7 prisons working with Project ECHO found that the care they provided was just as safe and effective as that received at the University of New Mexico hepatitis C clinic. As of 2009, 3,500 patients were being treated for hepatitis C at Project ECHO sites. Project ECHO has since expanded to include treatment for HIV/AIDS, diabetes, asthma, chronic pain, high-risk pregnancy, and psychiatric disorders, to name a few.