Most Tuesdays at 7:30 a.m., Dr. Magni Hamso gets on her computer at Terry Reilly Health Services in Boise and logs onto a website. Up pops a screen with about a half dozen live feeds of other health care workers and experts from around the region who have also logged in.
They’re participants in a weekly “teleclinic” on liver and gastrointestinal care. For about a year, Hamso has been turning to this group of mentors and peers to discuss challenging cases, to seek guidance on her treatment plans and to learn about the latest issues and developments in liver, gastrointestinal and hepatitis C care.
Welcome to Project ECHO.
HUBS AND SPOKES
Project ECHO — Extension for Community Health Outcomes — uses interactive video conferencing to link medical specialist teams with health care providers in rural and underserved areas.
Launched by the University of New Mexico in 2003, Project ECHO now operates 39 hubs for nearly 30 diseases and conditions in 22 states and six countries, including sites within the Department of Defense health care systems, according to the University of New Mexico.
The University of Utah created a hub and held its first interactive video clinic in October 2011.
The program is free to users. It now has spokes in several Western states, including Idaho. About 60 Idaho medical providers are registered with Utah’s Project ECHO. About 10 participate regularly in the weekly video clinics. Others tune in when they have a particular case or issue.
Most work in rural areas, though some, like Hamso, are urban.
“We are making sure people who are in remote areas are getting the same level of care that is available to other people,” said Dr. Terry Box, a University of Utah School of Medicine assistant professor and Project ECHO medical director.
Only about 10 percent of doctors practice in rural areas, though nearly 1 in 4 Americans lives in them.
“We are really focusing on getting the right medicine at the right time and the right place, so you do not have to drive 300 miles round trip to spend 20 minutes with a specialist,” Box said. “We are increasing access, and we are saving money.”
LESSONS APPLIED TO MORE PATIENTS
Utah started its program with a hepatitis C teleclinic to help health care providers in rural areas treat patients suffering from the disease, which is chronic and sometimes fatal, Box said. Since then, Utah’s teleclinics have expanded to about a dozen topic areas including gastrointestinal and liver care, mental illness, pregnancy care, genetic counseling, burn and soft-tissue injury, and trauma.
The program differs from patient/doctor telemedicine, where a patient has a video conference with a doctor. The patients are not seen. Instead, their doctors are mentored by the specialists.
“It is an amazing service,” Hamso said. “Boise is a big city, but we still do not have as many liver specialists as in Seattle or Salt Lake, so the fact that we are able to tap into their expertise means that we can be confident treating hepatitis C here.
“There is this multiplying effect, because they remotely supervise us and give us support with a complicated patient, and we treat those patients and then go on to treat many more patients.”
Dr. David Hachey, a professor at Idaho State University’s family medicine program in Pocatello, joined the University of Washington’s ECHO program for hepatitis C in 2010. Last year, he also joined Utah’s project.
“We had a gentleman in his 50s who was uninsured,” Hachey said. “He had very progressed liver disease. He was diagnosed at the time with hepatitis C. He did not know he had it.”
Hachey presented the case, lab tests and a treatment plan via ECHO to Box, who helped him fine-tune it.
“Low-volume providers have access to hepatologists, substance-abuse specialists and pharmacists who can help,” Hachey said. Because some insurance companies and Medicaid programs require that patients with certain conditions be treated by a specialist, he said, “some of our patients would not have been approved (for treatment) had we not been participating in Project ECHO.”
Now, some lawmakers in Congress would like to see ECHO integrated into health systems across the country.
In April, Sens. Orrin Hatch, R-Utah, and Brian Schatz, D-Hawaii, introduced the ECHO Act, which would require federal health care leaders to analyze the ECHO model and study how it can be adopted and funded.
“In states with large rural populations like Utah, it’s vital that we do everything we can to ensure that patients have access to quality health care — no matter where they live,” Hatch said in a news release.