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UNMH's rural medicine program expands

The School of Medicine’s rural healthcare initiative, Project ECHO, is being presented to the United States Senate on Tuesday in the hopes of having it implemented into the international health system.

Also known as the Extension for Community Healthcare Outcomes, the project was started at UNM in 2003, with the goal of “dramatically increasing access to specialty treatment in rural and underserved areas.” Since then it has been implemented by 103 partners — 64 in the U.S. and 39 internationally.

Sanjeev Arora — a professor at the UNM School of Medicine, as well as the founder and director of Project ECHO — said its goal is to touch the lives of 1 billion people by 2025 through its efforts to “revolutionize medical education and exponentially increase workforce capacity,” according to its website.

“We developed ECHO with two goals: one is to get Hepatitis C treatment to everyone in New Mexico, and second, to essentially get to everyone in New Mexico,” Arora said. “Then we would have a model to treat complex diseases in rural locations, developing countries and everywhere,” Arora said.

In 2003-2004 there were 28,000 patients with Hepatitis C in New Mexico, and they were coming from all over the state to be treated at UNM Hospital, Arora said. At that time, there was an eight month wait to receive the necessary medical attention.

“People would drive hundreds of miles each way — making 12 to 18 trips to get one course of treatment,” Arora said.

One of the big challenges, he said, was getting treatment to the undiagnosed who could not afford to travel for medical attention.

Arora said after the model for Hepatitis C treatment — centered around multiple specialists from around the state conversing about treatments through livefeeds — became a successful formula, they realized doctors and nurses in New Mexico were learning a lot from it.

Meanwhile, professional isolation was going down and it was a “particular joy of growth” for rural doctors, who are especially isolated.

Once they realized it was working, Arora said his team made a study and published it in the “New England Journal of Medicine,” showing that doctors, orderlies and attendants could provide the same level of care as was being provided at the University.

This also led to the realization that ECHO could be used to address many other diseases, he said.

“We started doing it for diabetes, mental health disorders, addiction disorders, for chronic pain and others,” Arora said.

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Once they published their findings showing ECHO was working for a variety of different areas, essentially delivering the same quality of care in rural areas as was being offered at UNMH, Arora said there was much interest from all around the country to replicate the model.

“The problem with medicine is that knowledge is expanding at a very fast pace, and rural doctors just can’t keep up with it,” Arora said. “We have developed a methodology basically to distribute this knowledge effectively, so people in rural and underserved areas can get best practice care.”

A chance at going national

An ECHO Act is being presented to the U.S. Senate on Tuesday encouraging a national political initiative to study the model and find ways to incorporate it on a national scale.

Erika Harding, director of Replication Initiatives at ECHO, said that the project being taken to the Senate is an extraordinary step that has taken them by surprise.

The initiative is led by a couple of ECHO’s replication partners: Sen. Brian Schatz, D-HI, and Sen. Orrin Hatch, R-UT, she said. The two senators initiated an effort to create a bill that would bring attention and research to investigate the power and impact of the model in the U.S.

“Honestly we didn’t know what to expect with the change of administrations, but somehow in recent weeks the bill has really caught the eye of a lot of people in the Senate,” Harding said.

The effort to create the bill received a good amount of support, including from the New Mexico delegation across both parties, to look at the model as a powerful way of implementing healthcare expansion efforts and extending access.

Harding, who has worked with Project ECHO for eight years, said the first and most important community served is New Mexico’s underserved population, as ECHO offers more than 20 programs to expand access to specialty camps for New Mexicans in all areas.

Currently there are more than 400 community coalitions, ranging from specialists to doctors and nurses all the way to the community health workers that have participated in ECHO over the years, she said.

This has helped the team gain knowledge and expertise they didn’t have before, Harding said, making them able to offer care to patients they couldn’t assist before.

“That is a well-established benefit that we’re very proud of,” Harding said.

Project ECHO hasn’t done it alone, however, and has been in collaboration with the New Mexico legislature and other care clinics such as the primary care association, she said.

“That’s pretty cool (that) we have lots of communities we serve,” Harding said. “Ultimately Echo allows people to serve their own communities.”

Harding is in charge of the replication and expansion of the initiative, so her work ties into sharing the model with others so they can turn around and use it themselves to address their own problems using their own local resources, she said.

“It’s a model for sharing,” she said. “My personal ambition is to build a strong team that can share this model as effectively and efficiently as possible, so that we can address the world health disparities.”

There’s a lot of smart people with a lot of smart answers, she said, but not enough people have access to that knowledge.

Both Arora and Harding invite students to come to visit the ECHO Institute to observe the work they do.

Arora said students can also attend a variety of ECHO events, such as their monthly event called an “ECHO introduction” where he speaks about the project, and people join from all over the world via the internet.

Another event organized by the Project ECHO team, called the ECHO Immersion, is a seminar that lasts for three days where people are taught how to implement the model, as well as receive all of ECHO’s software and access to video content and platforms at no cost to them, he said.

After the event, attendants go back to their areas of medical practice and essentially implement ECHO in their communities. Universities that have implemented the model so far include the University of Washington and the University of Texas, Arora said. “It’s become more of a movement around the world,” he said.

Nichole Harwood is a news reporter at the Daily Lobo. She can be reached at or on Twitter @Nolidoli1.

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