On Jan. 4, clinicians across New York State booted up their computers and logged into a virtual classroom, each ready to learn how to improve care for their patients. It was the first of many planned meetings under a new program launched by Mount Sinai's Institute for Advanced Medicine that aims to decentralize specialist knowledge from New York City to smaller cities and towns throughout the state.
The Mount Sinai program is modeled after a successful telementoring program called Project ECHO, originally pioneered in 2003 by Sanjeev Arora, M.D., to help clinicians safely treat patients with hepatitis C (HCV) in rural New Mexico. Project ECHO programs have since expanded to include 55 diseases and are being used in 21 countries.
The Mount Sinai program, officially called Clinical Education Initiative (CEI) HIV ECHO, will provide telementoring sessions around HIV treatment and prevention. It joins a sister-site program based at the University of Rochester, which focuses on sexually transmitted diseases (STDs). All Project ECHO programs are structured as peer-to-peer training sessions in which specialists comprise the "hub," and clinicians in smaller cities and rural areas comprise the "spokes." It relies heavily on the videoconference system Zoom, similar to Google Hangouts, to create a virtual classroom setting.
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Mount Sinai's CEI, the HIV/HCV Center of Excellence, which is based in New York City, acts as the hub of a network of clinicians spread across the state, some as far away as Lockport, near Niagara Falls, and others as near as Harlem. The CEI HIV ECHO program's multidisciplinary expert panel includes internist Antonio Urbina, M.D.; nurse practitioner Jeffrey Kwong, D.N.P., M.P.H.; psychiatrist Hansel Arroyo, M.D.; pharmacist Chris Nguyen; and social worker Emma Cooper-Serber, M.P.H., M.S.W.
This group will convene once a month to share case studies and exchange tips on progressive treatment strategies. "Although we have 'clinical experts' on our panel, we are all teachers and we are all learners during the CEI HIV ECHO sessions," said Terri L. Wilder, M.S.W., director of HIV/AIDS Education and Training at the Mount Sinai Institute for Advanced Medicine, and director of the HIV/HCV Center of Excellence.
The CEI HIV ECHO program is funded by a grant from the New York State Department of Health AIDS Institute. As the HIV/HCV Center of Excellence, "our job is essentially to train every medical provider in the state of New York on HIV and hepatitis C-related topics," Wilder explained.
In 2011, Arora's Project ECHO program was demonstrated to be an effective way to improve local health care, according to a study published in the New England Journal of Medicine. The New York State Department of Health AIDS Institute became interested in bringing the Project ECHO model to New York, so in 2015 Wilder attended the training offered at Arora's flagship "hub" at the University of New Mexico School of Medicine.
"I traveled to New Mexico with some of our colleagues from the New York State Department of Health and from our sister site at the University of Rochester to attend a Project ECHO training," Wilder said. Wilder completed her HIV training program in just under a week, and then flew back to New York to start laying the groundwork for Mount Sinai's CEI HIV ECHO.
"About a year later we got the green light, and we started to build the infrastructure necessary to launch the program," she said. The CEI HIV ECHO team recruited potential "spokes" by advertising the program online and distributing information through email listservs. The first meeting, which was held on January 4, was a success, she said. Ultimately 17 clinicians participated.
During the meeting, Wilder summarized Governor Andrew Cuomo's three-point plan to end HIV/AIDS in New York State. The expert panel reviewed two case studies while "spoke" clinicians chimed in remotely. Because it was the first meeting, Wilder explained, the case studies were pre-selected. However, in future meetings two "spoke" clinicians will volunteer to present cases for an open discussion on best practices, she said.
The second Project ECHO meeting, which reviewed the primary caregiver's role in HIV treatment, was held on February 1, 2017, and subsequent meetings will be held on March 1, April 5, May 3 and June 7. The CEI HIV ECHO program will continue to evolve as the group develops a rapport and as more people sign up.
"Our funder [New York State Department of Health AIDS Institute Clinical Education Initiative] is very supportive of CEI HIV ECHO and will most likely want us to continue with this indefinitely," said Wilder. "In a year or so, we may consider starting a hepatitis C ECHO for the state of New York, which will probably be very popular since we can now cure hepatitis C," she said.
Are you a New York medical provider interested in participating in CEI HIV ECHO?
Contact Robert Walsh at Robert.Walsh@mountsinai.org for more information.
Sony Salzman is a freelance journalist reporting on health care and medicine, who has won awards in both narrative writing and radio journalism. Follow Salzman on Twitter: @sonysalz.