Project ECHO Hepatitis C Ambulatory Care Quality Improvement in New Mexico through Health Information Technology

Hepatitis C virus (HCV) infection is a significant public health problem. The Centers for Disease Control and Prevention (CDC) estimates that 3.9 million people in the U.S. are infected with the disease and are at risk of developing liver cirrhosis and liver cancer. Treatment of HCV and eradication of the virus prevents future complications, but few patients outside the urban academic setting are able to receive adequate treatment. New Mexico-based Project ECHO – Extension for Community Healthcare Outcomes – partners with primary care clinicians throughout the State to safely and effectively treat HCV. ECHO trains and supports rural health care professionals so that rural patients receive the same level of care as patients at academic medical centers.

This project built on the work of Project ECHO: Extension for Community Healthcare Outcomes, previously funded by the Agency for Healthcare Research and Quality. This new project developed and deployed iHealth, an Internet-based disease management tool. iHealth collects data and generates reports to enhance management of HCV. The project focused on creating additional iHealth features and promoting its adoption.

The specific aims of this project were to:

• Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. 
• Develop a Web portal that creates a central identity for the HCV program and provides a single access point for its resources. 
• Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. 
• Develop a system that automatically uploads laboratory data from TriCore. 
• Promote adoption of iHealth clinical management system. 

Focus groups with patients and clinicians were conducted throughout the project to elicit information about needs, desired tools and content, and the likelihood of iHealth and clinician and patient Web portals use. These sessions identified barriers to adopting the tool and provided feedback for the development of improved training tools. Pre- and post-tool implementation surveys were conducted. Prior to full release, iHealth was tested to get feedback on usability and acceptability.

The project team successfully designed and implemented the iHealth tool. The Web portal for clinicians was completed, and a prototype for a patient portal was developed. Adoption of the iHealth tool was promoted by identifying user needs, soliciting feedback, and providing enhanced training. Analytic data marts were created so that subsets of data could be extracted from the database to develop outcome studies. The project created the ability to automatically upload laboratory data into iHealth. At the end of the grant period, tools to support ad hoc reports, a data dictionary, and search tools to enhance iHealth were being developed.

Patient and clinician focus groups indicated that an HCV patient portal would be a valuable tool for patients to access disease information, treatment status, and to educate themselves and others about the disease. Clinicians supported the idea of a patient portal. The project team was able to demonstrate that iHealth is a useful tool in the treatment of HCV that participants were willing to use.