TMC PULSE

t m c » p u l s e | m a y 2 0 1 5 29 This is more telementoring than telemedicine. We're teaching them how to treat these complex diseases they didn't realize they could treat. — SAIRA KHADERI, M.D. Associate Director of Project ECHO and Assistant Professor of Surgery at Baylor College of Medicine patient care through the providers in the community. "This is more telementoring than telemedicine," said Saira Khaderi, M.D., associate director of Project ECHO and an assistant professor of surgery at Baylor College of Medicine. "We're teaching them how to treat these complex diseases they didn't realize they could treat. We're reaching out to however many sites, but each one of those sites is treating 10 patients and it continues to expand from there." For Madu, Project ECHO has provided an opportunity to expand her skill set far beyond what she learned in school. Madu works as a physician assistant at a federally qualified health center affiliated with Baylor St. Luke's. "Project ECHO provided a way of getting the test from Wayne Gosbee and having access to these specialists who know so much about these medica- tions," said Madu. "I didn't get trained specifically for hepatitis C, I was just general medicine. It was a way of broad- ening my knowledge base. It's taught me a lot, and increased my confidence level. It's a big deal." Madu is the provider responsible for treating John Rocks. After Rocks' hepa- titis C diagnosis, he had no idea where to turn. At the time, he barely even knew what hepatitis C was, let alone what his prognosis would be. Internet searches only increased his despair. "I found out it will kill you—they called it 'the silent killer,'" Rocks said. "I thought I was up a creek without a paddle. No money, no insurance. I'd just turned 50 years old, and to find out I had this disease? It was a shocker." Rocks suspected he contracted the virus from a blood transfusion after a motorcycle accident in the '80s. Having read a lot of dire information about hepatitis C online, Rocks headed to a local doctor's office, where he spoke frankly with the receptionist. "I said, 'Well, ma'am, I don't have any insurance. If there's no cure, this is just like throwing my money away,'" he recounted. "She said, 'You know what? Call this number.'" The phone number belonged to Wayne Gosbee. After Gosbee con- firmed Rocks' hepatitis C diagnosis, he was referred to Madu's clinic for further treatment and his case proceeded like any other in Project ECHO. Lizette Escamilla, Project ECHO coordinator, sends email blasts to all providers connected with the program, like Madu, to let them know of sched- uled hepatitis C clinics and to ask for patients to present. She sends forms to the providers, which cover information such as past medical history, time of diagnosis, any secondary complications and complete blood counts. "I create the agenda and the provid- ers are placed in the queue to present their cases one by one. We've had from 12 to 20 up on the screen for hepatitis C," said Escamilla. "One presents at a time, but everyone else is listening as well. They're able to give comments and ask questions." Patients remain completely anon- ymous throughout the process. Baylor St. Luke's physicians are not provided their names or any other identifying information. They simply consult based on the medical details providers share with them. "It isn't like they give us information and we just say, 'Do this,'" said Sussman. "We're engaging in a conversation. After one or two cases, [Madu] was telling us what she wanted to do. She became so confident in managing this, and now she can teach others." With Rocks' blessing, Madu pre- sented his case during one of the clinic teleconferences. Based on the advice of Baylor St. Luke's doctors, Madu put him on a 90-day regimen of an oral medication to treat hepatitis C. By the time 90 days were up, Rocks no longer showed any signs of hepatitis C. He is the first patient with the Project ECHO to be cured, but if all goes according to plan, this is only the beginning. In addition to hepatitis C, Project ECHO also currently offers clinics in hepatitis B, advanced liver disease, infectious disease, and cardiol- ogy, with plans to expand further. "In the summer and fall, we're going to open up other clinics like nephrol- ogy, pulmonary, rheumatology," said Escamilla. "We're also working to offer behavioral health services. We're talking with many physicians who are generous with their time and would like to volunteer to lead a Project ECHO clinic." As the program looks to expand, Rocks' experience has everyone at Project ECHO excited for the future. Though Rocks didn't know it at the time, the moment that recep- tionist placed Wayne Gosbee's phone number in his hand proved to be life-changing. Project ECHO physicians sit in a conference room at Baylor St. Luke's, consulting with community providers over teleconference. (Credit: Baylor St. Luke's) "One minute I thought I was dying, a year later I was cured of the disease," he said. "It's just a blessing. Amen for ECHO." The value of Project ECHO goes far beyond delivering care to underserved communities. It's empowering provid- ers in those communities, giving them the knowledge and the confidence to help the people they serve in ways they may not have believed possible. Madu grew teary-eyed as she spoke of the moment she told Rocks he was cured of hepatitis C. "To tell someone with an infectious disease, 'It's cured, it's gone. You don't have the virus in your system,' it makes you feel good inside," she said. "And now he can think long-term again about his life."

• Cover