By Allison Proffitt
November 24, 2008 | When the University of New Mexico wanted to get a better handle on the state’s hepatitis C problem, they turned to consultant Infosys Technologies and created Project ECHO, a web-based solution to link care providers and patients all over the state with experts at the university.
Several years ago, hepatitis C cases were spreading in New Mexico, and researchers did not have the data they needed to track cases or study the causes and trends. Especially in rural areas, prisons, and Native American populations, there was under-education about hepatitis C symptoms and treatment options, and local physicians didn’t have access to experts.
Sanjeev Arora, a hepatitis C specialist at the University of New Mexico, drove Project ECHO and secured a grant from the HHS Agency for Healthcare Research and Quality (AHRQ). Project ECHO’s mission is to develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas, and to monitor outcomes of this treatment. Hepatitis C is its first focus.
Arora wanted to make better use of a telemedicine initiative that the University of New Mexico already had in place, and connect remote medical sites with core hospitals to make it easy for clinicians to collect, capture, and report information on a timely basis.
Managing and moving this data was Infosys’ job. “The application is really around data management,” says Mark Brownlee, associate VP, healthcare practice at Infosys. “The telemedicine capability was really just the connections between [the UNM hospital] and other facilities in the state. What we brought to the table was this technology solution that helped UNM use the telemedicine network to get a better handle on what was happening with hep C in the state.”
What Infosys created is similar to a RHIO (regional health information organization), but limited to hepatitis C. “Participating physicians throughout the state are collecting the same types of information, codifying it, communicating across the network in a very controlled, very structured way,” says Brownlee, “The state can make use of it, individual physicians can make use of it, and researchers within the University of New Mexico Medical Center can make use of it.”
Infosys used some of the latest .NET technology to build a web-based data management tool that features very dynamic forms specific to hepatitis C. “There’s a technique we employed where a physician or physician’s assistant could essentially design whatever data collection form they wanted, using essentially drag and drop capabilities. So different hospitals, different physicians, different clinics across the state could really design how they wanted to manage hepatitis C locally, but still be able to provide the core information back through the network to the university,” Brownlee explains.
This flexibility ensures physician buy-in, Brownlee says. “It was a simple idea that we’re not going to tell anybody what they have to do, but we’re going to give them the capability to participate if they want, and to participate their way. But to the extent that they do participate, it will be a very controlled level participation; … known information in being collected in a known format that is easily consumed so that other people can take advantage of it.”
Giving the user so much flexibility is technically difficult. “We were able to find a way to implement that vision of not prescribing how hepatitis C should be managed in local clinics, but letting local clinics design how they want to do it on their own and design the forms on their own… Instead of very tactically estimating the cost to write custom forms for multiple entities within the system, we only needed to design one generic, highly configurable form and process workflow that other people can modify within the application,” Brownlee says.
The approached saved the University of New Mexico money. Competitors’ estimates for the project had reportedly been in the $1 million to $1.5 million range. Infosys was able to deliver their solution for about $250,000.
The result has greatly increased communication between care givers all over the state. The university “conducts these clinics, what they call their knowledge management clinics, where the [UNM expert] physicians and the local physicians interact with each other,” explains Praveen Soti, principal and practice manager, healthcare consulting at Infosys. “They talk about the presenting complaints, any new findings, any new investigation data… What that allows them to do is to improve the capacity of these end physicians or clinical care givers, to learn more from these specialists, who are right now sitting in the UNM hospital itself.”
The approach is working well, and the University of New Mexico hopes to expand the program into other disease areas. Project ECHO is based on the principle of “instilling a really specific best practices-based care model for hepatitis C,” says Soti. Based on the success of Project ECHO’s work with hepatitis C, the New Mexico government has encouraged researchers to expand the program to address other issues, possibly including teen pregnancy, sexually transmitted diseases, asthma, obesity, and others.