For Rural Clinicians, a Virtual Consult

When Chris Ruge, FNP-BC, a nurse practitioner in rural New Mexico, thinks of his biggest success stories, a particular patient comes to mind. She’s a mom who underwent several different surgeries and in the process became hooked on pain medication. Over time, she was dealing with a full-blown addiction.

Since patients who live in this part of New Mexico have to drive three hours each way to receive treatment at the University of New Mexico (UNM) in Albuquerque, most never make the trip. Project ECHO, an innovative program at the UNM School of Medicine, has changed all that by knocking down rural barriers to access.

Ruge is a participant in this unique telemedicine program. He presented his patient’s case to a panel of addiction experts at UNM via a remote hook-up. They guided him as he treated her dependence on pain meds. Gradually, she recovered and started to find more energy for positive things in her life, such as coaching her kids’ sports teams.

During a routine follow-up visit, the woman brought her 11-year-old daughter with her. “Oh, thank you,” the girl said to Ruge. “Now I have my mom back.”

SPECIALTY CARE, NEAR AND FAR
Thanks to Project ECHO (Extension for Community Healthcare Outcomes), founded by Dr. Sanjeev Arora in 2003, clinicians across New Mexico can point to many similar success stories. “It started as a way to increase access to care for hepatitis C,” says Karla Thornton, MD, associate medical director of Project ECHO and a UNM professor in infectious disease. “The model works so well, it’s been expanded to include a lot of different diseases.”

The program—which has won many awards, including one from the Robert Wood Johnson Foundation—relies heavily on nurse practitioners, like Ruge, and physician assistants. “They become specialists,” Thornton says, “so they can provide care for their patients in their own community.”

Through the ECHO program, Ruge can share patients’ labs and medical information with a panel of experts at UNM, including Arora, who is a hepatologist. After consulting with the group, he returns to the patient and carries out a specialized treatment plan—in the local clinic close to the patient’s home.

Another clinician in the ECHO network, Debra Newman, PA-C, MPAS, MPH, admits that when she first signed on with the ECHO program, she was a little intimidated by the technology, but she got the hang of it. Basically, all it takes is a computer, a Web cam, and the right software. Every Wednesday, Newman plugs in an IP address and suddenly, the UNM group appears on her screen, sitting around a big conference table. Then providers from other rural clinics also pop up on her screen in a series of smaller boxes.

Each rural provider presents a case, then gets feedback from the UNM multidisciplinary team of experts. “It’s almost like in medical school,” Thornton explains, “where you present the patient to the attending physician.”

Ruge participates in several ECHO program clinics, including those for addiction, hepatitis C, and diabetes. With his background as a small-business owner, Ruge says, he likes the sense of autonomy the program gives him. He also likes the way the UNM team treats clinicians with courtesy, as fellow professionals.

“It allows me to create my own kind of program here, with Project ECHO giving it structure,” Ruge says. “How I coordinate the program, that comes from me.”

KEEPING UP TO DATE
When Ruge started working in rural New Mexico, he had a strong background in addiction medicine but didn’t know as much about how to manage diabetes. He received quite an education by joining the ECHO program’s diabetes clinic. In particular, he appreciates the way other clinicians share their tips for helping diabetic patients with lifestyle changes, such as diet and exercise.

When he logs on to the virtual clinic, there will be, say, an endocrinologist sitting at the table, along with a diabetes educator and several nurse care managers. “When you present, it really is just as if the patient has gone to an endocrinology expert, and you’re sitting there talking about it afterward,” Ruge says. “I’ve learned so much by working with them.”

He also appreciates the support and education ECHO provides. “With hepatitis C, it’s similar to AIDS care about 15 years ago,” Ruge says. “The treatments we have are not always as effective as we would like them to be. It’s kind of like frontier medicine—you need to feel like someone has your back so you can push that envelope.”

Participation in the ECHO program’s hepatitis C clinic also gives clinicians access to the latest drugs and research, since the panel shares information about up-and-coming clinical trials. Ruge can share the latest data about his patients through a sophisticated electronic medical record system.

“They are really going the extra mile to get good data and good labs,” Ruge says of the specialists at the other end of the program.

A BLESSING FOR PATIENTS
The patient Newman will always remember is a man who had started using drugs, including heroin, as a young teenager. He had been incarcerated several times. Newman started giving him suboxone for opiate replacement therapy.

“He became stable, he stopped smoking, and we got some counseling in place,” Newman says. “Then we started hepatitis C treatment.”

Newman was thrilled to get the news that this young man, who is now in his 20s, has been cured of his hepatitis C. “He is planning to move to Colorado and start a whole new life,” she says, with pride. “Without the ECHO program, there would be so many people like him who would not be able to get treatment. It’s such a blessing.”

This is a sentiment Ruge echoes. During his first year and a half with the ECHO program, Ruge started 19 patients on treatment for hepatitis C. “I can honestly say probably half of them would not have been treated within the next five years, if at all,” he surmises, “because the hurdles are too great.”

Many of his patients have very low incomes, so the $30 to $40 it would cost in gas to make the trip to Albuquerque would be a barrier for them, Ruge explains. Others don’t even own a car. If any of them tried to make the trip but were delayed by a snowstorm and had to postpone their appointment, they might never reschedule, he adds.

Because of the ability to help so many, the ECHO program has made Newman feel great about her work. “I’m really happy I landed in this,” she says. “This is like a dream job.”

GREAT OPPORTUNITY FOR PAs, NPs
PAs and NPs are well suited to this unique program, according to Newman. “Generally speaking, we’re given a little bit more time to talk to patients,” she says. “We tend to do more of the education piece, so I think it’s a good fit.”

Another plus: Clinicians who participate in the ECHO program can receive continuing medical education credit. And each clinic has a weekly education session or didactic presentation. “I love to learn,” Newman says. “I love having that available to me all the time. It just makes my job that much more enjoyable.”

Clinicians in other states may eventually have similar opportunities. The UNM model has been so successful at improving access to care that many other medical centers—such as the University of Chicago and the University of Washington—are taking Arora’s idea and adopting a similar system.

“It sort of spread in a way he never imagined,” Thornton says. “It’s really a great program. It provides care for people who couldn’t otherwise have it.”

For more information about the ECHO program, visit echo.unm.edu or send an e-mail to echo@salud.unm.edu.

When Chris Ruge, FNP-BC, a nurse practitioner in rural New Mexico, thinks of his biggest success stories, a particular patient comes to mind. She’s a mom who underwent several different surgeries and in the process became hooked on pain medication. Over time, she was dealing with a full-blown addiction.

Since patients who live in this part of New Mexico have to drive three hours each way to receive treatment at the University of New Mexico (UNM) in Albuquerque, most never make the trip. Project ECHO, an innovative program at the UNM School of Medicine, has changed all that by knocking down rural barriers to access.

Ruge is a participant in this unique telemedicine program. He presented his patient’s case to a panel of addiction experts at UNM via a remote hook-up. They guided him as he treated her dependence on pain meds. Gradually, she recovered and started to find more energy for positive things in her life, such as coaching her kids’ sports teams.

During a routine follow-up visit, the woman brought her 11-year-old daughter with her. “Oh, thank you,” the girl said to Ruge. “Now I have my mom back.”

SPECIALTY CARE, NEAR AND FAR
Thanks to Project ECHO (Extension for Community Healthcare Outcomes), founded by Dr. Sanjeev Arora in 2003, clinicians across New Mexico can point to many similar success stories. “It started as a way to increase access to care for hepatitis C,” says Karla Thornton, MD, associate medical director of Project ECHO and a UNM professor in infectious disease. “The model works so well, it’s been expanded to include a lot of different diseases.”

The program—which has won many awards, including one from the Robert Wood Johnson Foundation—relies heavily on nurse practitioners, like Ruge, and physician assistants. “They become specialists,” Thornton says, “so they can provide care for their patients in their own community.”

Through the ECHO program, Ruge can share patients’ labs and medical information with a panel of experts at UNM, including Arora, who is a hepatologist. After consulting with the group, he returns to the patient and carries out a specialized treatment plan—in the local clinic close to the patient’s home.

Another clinician in the ECHO network, Debra Newman, PA-C, MPAS, MPH, admits that when she first signed on with the ECHO program, she was a little intimidated by the technology, but she got the hang of it. Basically, all it takes is a computer, a Web cam, and the right software. Every Wednesday, Newman plugs in an IP address and suddenly, the UNM group appears on her screen, sitting around a big conference table. Then providers from other rural clinics also pop up on her screen in a series of smaller boxes.

Each rural provider presents a case, then gets feedback from the UNM multidisciplinary team of experts. “It’s almost like in medical school,” Thornton explains, “where you present the patient to the attending physician.”

Ruge participates in several ECHO program clinics, including those for addiction, hepatitis C, and diabetes. With his background as a small-business owner, Ruge says, he likes the sense of autonomy the program gives him. He also likes the way the UNM team treats clinicians with courtesy, as fellow professionals.

“It allows me to create my own kind of program here, with Project ECHO giving it structure,” Ruge says. “How I coordinate the program, that comes from me.”

KEEPING UP TO DATE
When Ruge started working in rural New Mexico, he had a strong background in addiction medicine but didn’t know as much about how to manage diabetes. He received quite an education by joining the ECHO program’s diabetes clinic. In particular, he appreciates the way other clinicians share their tips for helping diabetic patients with lifestyle changes, such as diet and exercise.

When he logs on to the virtual clinic, there will be, say, an endocrinologist sitting at the table, along with a diabetes educator and several nurse care managers. “When you present, it really is just as if the patient has gone to an endocrinology expert, and you’re sitting there talking about it afterward,” Ruge says. “I’ve learned so much by working with them.”

He also appreciates the support and education ECHO provides. “With hepatitis C, it’s similar to AIDS care about 15 years ago,” Ruge says. “The treatments we have are not always as effective as we would like them to be. It’s kind of like frontier medicine—you need to feel like someone has your back so you can push that envelope.”

Participation in the ECHO program’s hepatitis C clinic also gives clinicians access to the latest drugs and research, since the panel shares information about up-and-coming clinical trials. Ruge can share the latest data about his patients through a sophisticated electronic medical record system.

“They are really going the extra mile to get good data and good labs,” Ruge says of the specialists at the other end of the program.

A BLESSING FOR PATIENTS
The patient Newman will always remember is a man who had started using drugs, including heroin, as a young teenager. He had been incarcerated several times. Newman started giving him suboxone for opiate replacement therapy.

“He became stable, he stopped smoking, and we got some counseling in place,” Newman says. “Then we started hepatitis C treatment.”

Newman was thrilled to get the news that this young man, who is now in his 20s, has been cured of his hepatitis C. “He is planning to move to Colorado and start a whole new life,” she says, with pride. “Without the ECHO program, there would be so many people like him who would not be able to get treatment. It’s such a blessing.”

This is a sentiment Ruge echoes. During his first year and a half with the ECHO program, Ruge started 19 patients on treatment for hepatitis C. “I can honestly say probably half of them would not have been treated within the next five years, if at all,” he surmises, “because the hurdles are too great.”

Many of his patients have very low incomes, so the $30 to $40 it would cost in gas to make the trip to Albuquerque would be a barrier for them, Ruge explains. Others don’t even own a car. If any of them tried to make the trip but were delayed by a snowstorm and had to postpone their appointment, they might never reschedule, he adds.

Because of the ability to help so many, the ECHO program has made Newman feel great about her work. “I’m really happy I landed in this,” she says. “This is like a dream job.”

GREAT OPPORTUNITY FOR PAs, NPs
PAs and NPs are well suited to this unique program, according to Newman. “Generally speaking, we’re given a little bit more time to talk to patients,” she says. “We tend to do more of the education piece, so I think it’s a good fit.”

Another plus: Clinicians who participate in the ECHO program can receive continuing medical education credit. And each clinic has a weekly education session or didactic presentation. “I love to learn,” Newman says. “I love having that available to me all the time. It just makes my job that much more enjoyable.”

Clinicians in other states may eventually have similar opportunities. The UNM model has been so successful at improving access to care that many other medical centers—such as the University of Chicago and the University of Washington—are taking Arora’s idea and adopting a similar system.

“It sort of spread in a way he never imagined,” Thornton says. “It’s really a great program. It provides care for people who couldn’t otherwise have it.”

For more information about the ECHO program, visit echo.unm.edu or send an e-mail to echo@salud.unm.edu.

When Chris Ruge, FNP-BC, a nurse practitioner in rural New Mexico, thinks of his biggest success stories, a particular patient comes to mind. She’s a mom who underwent several different surgeries and in the process became hooked on pain medication. Over time, she was dealing with a full-blown addiction.

Since patients who live in this part of New Mexico have to drive three hours each way to receive treatment at the University of New Mexico (UNM) in Albuquerque, most never make the trip. Project ECHO, an innovative program at the UNM School of Medicine, has changed all that by knocking down rural barriers to access.

Ruge is a participant in this unique telemedicine program. He presented his patient’s case to a panel of addiction experts at UNM via a remote hook-up. They guided him as he treated her dependence on pain meds. Gradually, she recovered and started to find more energy for positive things in her life, such as coaching her kids’ sports teams.

During a routine follow-up visit, the woman brought her 11-year-old daughter with her. “Oh, thank you,” the girl said to Ruge. “Now I have my mom back.”

SPECIALTY CARE, NEAR AND FAR
Thanks to Project ECHO (Extension for Community Healthcare Outcomes), founded by Dr. Sanjeev Arora in 2003, clinicians across New Mexico can point to many similar success stories. “It started as a way to increase access to care for hepatitis C,” says Karla Thornton, MD, associate medical director of Project ECHO and a UNM professor in infectious disease. “The model works so well, it’s been expanded to include a lot of different diseases.”

The program—which has won many awards, including one from the Robert Wood Johnson Foundation—relies heavily on nurse practitioners, like Ruge, and physician assistants. “They become specialists,” Thornton says, “so they can provide care for their patients in their own community.”

Through the ECHO program, Ruge can share patients’ labs and medical information with a panel of experts at UNM, including Arora, who is a hepatologist. After consulting with the group, he returns to the patient and carries out a specialized treatment plan—in the local clinic close to the patient’s home.

Another clinician in the ECHO network, Debra Newman, PA-C, MPAS, MPH, admits that when she first signed on with the ECHO program, she was a little intimidated by the technology, but she got the hang of it. Basically, all it takes is a computer, a Web cam, and the right software. Every Wednesday, Newman plugs in an IP address and suddenly, the UNM group appears on her screen, sitting around a big conference table. Then providers from other rural clinics also pop up on her screen in a series of smaller boxes.

Each rural provider presents a case, then gets feedback from the UNM multidisciplinary team of experts. “It’s almost like in medical school,” Thornton explains, “where you present the patient to the attending physician.”

Ruge participates in several ECHO program clinics, including those for addiction, hepatitis C, and diabetes. With his background as a small-business owner, Ruge says, he likes the sense of autonomy the program gives him. He also likes the way the UNM team treats clinicians with courtesy, as fellow professionals.

“It allows me to create my own kind of program here, with Project ECHO giving it structure,” Ruge says. “How I coordinate the program, that comes from me.”

KEEPING UP TO DATE
When Ruge started working in rural New Mexico, he had a strong background in addiction medicine but didn’t know as much about how to manage diabetes. He received quite an education by joining the ECHO program’s diabetes clinic. In particular, he appreciates the way other clinicians share their tips for helping diabetic patients with lifestyle changes, such as diet and exercise.

When he logs on to the virtual clinic, there will be, say, an endocrinologist sitting at the table, along with a diabetes educator and several nurse care managers. “When you present, it really is just as if the patient has gone to an endocrinology expert, and you’re sitting there talking about it afterward,” Ruge says. “I’ve learned so much by working with them.”

He also appreciates the support and education ECHO provides. “With hepatitis C, it’s similar to AIDS care about 15 years ago,” Ruge says. “The treatments we have are not always as effective as we would like them to be. It’s kind of like frontier medicine—you need to feel like someone has your back so you can push that envelope.”

Participation in the ECHO program’s hepatitis C clinic also gives clinicians access to the latest drugs and research, since the panel shares information about up-and-coming clinical trials. Ruge can share the latest data about his patients through a sophisticated electronic medical record system.

“They are really going the extra mile to get good data and good labs,” Ruge says of the specialists at the other end of the program.

A BLESSING FOR PATIENTS
The patient Newman will always remember is a man who had started using drugs, including heroin, as a young teenager. He had been incarcerated several times. Newman started giving him suboxone for opiate replacement therapy.

“He became stable, he stopped smoking, and we got some counseling in place,” Newman says. “Then we started hepatitis C treatment.”

Newman was thrilled to get the news that this young man, who is now in his 20s, has been cured of his hepatitis C. “He is planning to move to Colorado and start a whole new life,” she says, with pride. “Without the ECHO program, there would be so many people like him who would not be able to get treatment. It’s such a blessing.”

This is a sentiment Ruge echoes. During his first year and a half with the ECHO program, Ruge started 19 patients on treatment for hepatitis C. “I can honestly say probably half of them would not have been treated within the next five years, if at all,” he surmises, “because the hurdles are too great.”

Many of his patients have very low incomes, so the $30 to $40 it would cost in gas to make the trip to Albuquerque would be a barrier for them, Ruge explains. Others don’t even own a car. If any of them tried to make the trip but were delayed by a snowstorm and had to postpone their appointment, they might never reschedule, he adds.

Because of the ability to help so many, the ECHO program has made Newman feel great about her work. “I’m really happy I landed in this,” she says. “This is like a dream job.”

GREAT OPPORTUNITY FOR PAs, NPs
PAs and NPs are well suited to this unique program, according to Newman. “Generally speaking, we’re given a little bit more time to talk to patients,” she says. “We tend to do more of the education piece, so I think it’s a good fit.”

Another plus: Clinicians who participate in the ECHO program can receive continuing medical education credit. And each clinic has a weekly education session or didactic presentation. “I love to learn,” Newman says. “I love having that available to me all the time. It just makes my job that much more enjoyable.”

Clinicians in other states may eventually have similar opportunities. The UNM model has been so successful at improving access to care that many other medical centers—such as the University of Chicago and the University of Washington—are taking Arora’s idea and adopting a similar system.

“It sort of spread in a way he never imagined,” Thornton says. “It’s really a great program. It provides care for people who couldn’t otherwise have it.”

For more information about the ECHO program, visit echo.unm.edu or send an e-mail to echo@salud.unm.edu.