TeleHealth Empowers Rural Clinicians to Treat HIV, HCV Locally

In rural New Mexico, scarce clinical resources exist for patients with chronic infectious diseases. The same goes for rural clinicians themselves, who have a tougher time accessing relevant continuing medication education (CME) than their more urban counterparts. Due to rapidly evolving treatment guidelines for HIV and hepatitis C (HCV), this education is necessary to deliver quality care to infected patients.

If a patient in rural New Mexico needs to see an infectious disease specialist, she might have to travel three to five hours for her appointment. Geographic isolation is a perfect fit for telemedicine solutions, and a program called Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico is using a new model to improve outcomes in rural communities.

Project ECHO is not "traditional telemedicine," said Michelle Iandiorio, M.D., medical director of Project ECHO HIV. Speaking at IDWeek 2015 in San Diego, California, Iandiorio described the success of Project ECHO, and what sets it apart from other TeleHealth programs.

As described by Iandiorio, "traditional telemedicine" typically involves virtual appointments between doctors and patients -- essentially a one-on-one doctor's appointment carried out using videoconferencing technology. Project ECHO instead endeavors to set up meetings between health care providers. During these multi-point virtual clinics, infectious disease specialists share their expertise with rural clinicians, empowering the clinicians to treat patients in their own communities instead of referring them to a far-away specialist in Santa Fe or Albuquerque.

This approach has been successful, according to landiorio. Rural patients treated locally by clinicians involved in Project ECHO had roughly the same virological suppression rates as patients treated in the University of New Mexico's hepatitis C clinic, she said.

Rural clinicians who opt in to Project ECHO receive CME credits free of charge and learn valuable information about how to treat their HIV and HCV patients. Moreover, once they feel comfortable treating these patients, they start to educate other providers in their communities, creating a "force multiplier" effect, said Iandiorio.

Project ECHO uses a web-based software similar to Google Hangouts. In these "virtual classrooms," lessons are taught with techniques like those employed in medical school training. Learning is case based, with community health clinicians sharing stories of patients from their own practices and soliciting advice from a specialist. With the virtual classroom approach, all participating practitioners learn from each shared case.

According to Iandiorio, some infectious disease specialists remain skeptical about Project ECHO. They fear that sharing their knowledge with community health clinicians will leave them without new patient referrals. However, as Iandiorio pointed out, the disease burden of patients with chronic infections far outweighs the resources of prescribing clinicians. Instead, she said, it is more likely that the community clinicians will be able to treat straightforward cases locally, while still referring patients who are truly in need of a specialist's care.

Since its inception, Project ECHO has moved beyond HIV and HCV to include TeleHealth programs for 30 different diseases. The program has also pushed beyond New Mexico, and is now up and running 22 states and five countries.

Iandiorio, who is in charge of the HIV arm of Project ECHO, is expanding its HIV education and training to Africa. In the next few weeks, her team will launch the first clinic in Namibia, she said.

Regardless of geography or resources, "chronic disease management is a team sport," Iandiorio emphasized. "Our goal is to touch the lives of one billion people by 2025."