This project is specifically focused on the following Health Information Technology (HIT) research area of interest: to improve healthcare decision making via the use of integrated data and knowledge management. Project ECHO (Extension for Community Healthcare Outcomes) is an innovative model for treating complex chronic diseases in rural and underserved areas of New Mexico. The Project trains rural healthcare professionals to provide the same level of care to rural patients as they would receive at an academic health center. The approach is based upon case-based learning delivered through a telemedicine infrastructure and Internet-based technologies to co-manage patients in community-based practices. With the support of the AHRQ (1 UC1 HS015135, PI: S. Arora, MD), Project ECHO has successfully bridged the gap in access to and outcomes of treatment for Hepatitis C virus (HCV) between urban and rural settings, thus paving the way for an ongoing State-funded program. As part of this effort, we have already deployed a prototype of an Internet based electronic treatment record called iHealth that is used to collect data and generate reports. Funding of this new application will allow us to program iHealth with additional features that support standardized data entry, improve treatment safety through warnings and automated treatment algorithms, provide practice support, facilitate extraction of aggregate data, and allow automatic data transfers between Project ECHO and its community laboratory partners. We further propose to make these functionalities available through a web portal. Thus, both the educational and treatment components of our HCV program will be based upon widely available technologies and therefore easily replicated by other institutions. We will promote the adoption of iHealth by identifying user needs and soliciting feedback;using clinical champions and other organizational strategies;using Project ECHO's distant learning model for iHealth training;and demonstrating that iHealth improves outcomes through structured management and reduces workload through practice support. The evaluation will be driven by theories describing the diffusion of innovation (Rogers and Orlandi) and focus on utilization, provider attitudes and beliefs, and changes in processes and outcomes. iHealth has significant potential to support Project ECHO's mission to improve health care quality and safety for rural populations and can readily be adopted to other chronic diseases.

Public Health Relevance

Project ECHO (Extension for Community Healthcare Outcomes) Health Information Technology solutions (HIT) proposed by this project will assist healthcare providers and multidisciplinary chronic care teams serving patients with (HCV) in rural, frontier and underserved areas in New Mexico to improve ambulatory care. Through the use of the iHealth clinical management system, as described in this proposal, patients with this complex, chronic disease will have improved quality of care, safety and transitions of care, and treatment outcomes. Providers and multidisciplinary chronic care teams will benefit from HIT solutions for practice support, knowledge sharing, efficient transitions of care, robust educational interventions, comprehensive telehealth education, and HCV certification. This initiative will support the dissemination of best practices of HCV treatment throughout New Mexico and ultimately underserved populations throughout the United States and the world.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Technology and Decision Science (HTDS)
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Nunley, Angela
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University of New Mexico
Internal Medicine/Medicine
Schools of Medicine
United States
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Arora, Sanjeev; Thornton, Karla; Komaromy, Miriam et al. (2014) Demonopolizing medical knowledge. Acad Med 89:30-2
Arora, Sanjeev; Kalishman, Summers; Dion, Denise et al. (2011) Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood) 30:1176-84