Dr. Joanna Girard Katzman is a neurologist, and the Director of the Chronic Pain and Headache Management TeleECHO clinic at the University of New Mexico Health Sciences Center in Albuquerque, NM.

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Questions

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Evelyn Corsini, MSW:

What are the mission and the history of Project ECHO at the University of New Mexico (UNM) Health Sciences Center?

Joanna Girard Katzman, MD, MSPH: The mission of Project ECHO is to develop the capacity via technology to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas, and to monitor outcomes of this treatment.

This program was the vision of Sanjeev Arora, MD, a physician at the UNM. He is one of the few hepatitis specialists in the state, and he became increasingly frustrated with his inability to provide care to the thousands of New Mexicans who suffer from hepatitis C. In rural and medically underserved areas patients often do not have access to a specialist, nor do they have the means to gain access to a specialist.

Project ECHO is funded in part by a grant from the Robert Wood Johnson Foundation. It has received support from the New Mexico Legislature, the University of New Mexico, and the New Mexico Department of Public Health.

Currently Project ECHO has over one dozen telehealth specialty clinics in operation.

EC: Describe how the Chronic Pain and Headache Management TeleECHO clinic program works.

JK: Project ECHO is an extension of community outreach. From my experience as a neurologist in a neuro-rehabilitation program, I saw how important the interdisciplinary services we provided were to our patients. We recognized, however, that we had 1,000 patients on the waiting list for the UNM clinic, and that some patients had to drive 5 or 6 hours to reach us.

Project ECHO leverages technology to bring together the full team of specialists at UNM as consultants to primary care providers throughout the state. Among others, the Chronic Pain and Headache program includes specialists in the areas of addiction, psychiatry, pharmacy, physical medicine and rehabilitation, and anesthesiology and interventional pain medicine.

There are several components to our program and we have traveled all over the state to teach and describe it. The healthcare providers who sign up for the program can join a two hour once a week session that provides one CME. The program is usually divided between a consultation on a case that has been faxed to us, and is presented via telephone or webcam, and didactic training on a major pain topic. Monthly sessions are devoted to a major pain topic and the weekly didactics support these topics.

EC: How do healthcare providers submit a case for consultation?

JK: We get more cases faxed to us than we can cover, but cases can be presented another week, or we can be contacted about urgent situations.

Our goal is to teach front line healthcare providers in these community settings, so that they will develop a greater level of expertise and comfort in managing their patients with chronic pain, and in turn, become a teacher to their colleagues.

The fax form for a Telehealth Clinic Case Presentation requires specific information, starting with “What is your main question about this patient?” We ask for a brief summary of current and past medical and surgical history and medications and pain treatments that have been tried. We also ask about symptoms of depression and anxiety, and if there is a history of substance abuse. A brief general examination form is included and a Brief Pain Inventory (Short Form).

Although we ask for the patient’s name and birthdate, that information remains confidential, as we assign a patient ID number that we use throughout the clinic visit.

EC: Are other healthcare groups copying your model and how can PainEDU users learn more?

JK: Yes, we have had many conversations with other organizations and are now partnering with other academic medical centers and federally qualified healthcare centers to help them replicate this program. Additionally, the VA, Army, and the Department of Defense are formally engaged with Project ECHO to replicate the successes of ECHO in helping to care for patients with chronic pain.

There is a great deal of information, including videos and slide presentations, on our website: http://echo.unm.edu/

[Editorial note: Users who go to the Chronic Pain and Headaches Management link on the site can watch a 3.5 minute video featuring Dr. Katzman, and a community healthcare provider who describes how the program has helped her improve patient care.]