Back in 2003, Sanjeev Arora, M.D., was frustrated that patients were waiting six to eight months to get treatment at his hepatitis C clinic at the University of New Mexico (UNM) hospital in Albuquerque.

"I could only treat 70 to 90 hepatitis C patients a year in my clinic, and there were more than 30,000 people with the disease in the state," he says.

Arora helped create Project ECHO (Extension for Community Healthcare Outcomes), which links specialists at UNM's school of medicine with rural clinicians to care for patients infected with the hepatitis C virus (HCV). Today, the six-year-old program helps rural New Mexico residents manage a dozen chronic diseases by putting a twist on the traditional use of telemedicine.

Rather than bringing patients to the remote experts, Project ECHO brings physicians and other caregivers to the experts. Each week, health care professionals from 21 primary care clinics across the state meet with Arora and other UNM physicians via interactive video to discuss cases and determine treatment.

For HCV alone, the project has held some 400 interactive audio-video clinics involving case presentations and management of more than 3,900 mostly lower-income patients.

"The idea is to learn from each other and help community providers manage their patients' care until they become experts in this area," says Arora, Project ECHO's director and executive vice chairman of UNM's department of medicine.

Under Project ECHO, providers engage in direct case-based learning as they treat their patients with a remote team of specialists in the fields of hepatology, psychiatry, infectious diseases, pharmacy and addiction.

"With Project ECHO, we have specialists in different fields who dial into our clinic every week," says April Grisetti-Nail, a certified physician assistant who treats patients in El Centro Family Health Center in Espanola, a city of less than 10,000 in north central New Mexico. "Through the videoconferencing network, we can bring specialty care to patients who might not otherwise have access to it."

The department of Health and Human Services has designated 32 of New Mexico's 33 counties as medically underserved areas.

The Robert Wood Johnson Foundation in August awarded a three-year, $5 million grant to support Project ECHO's effort to expand to other states and treat diabetes, asthma, rheumatology, mental health problems, chronic pain and high-risk pregnancy, in addition to HCV.

"We believe that this approach can help bring best practice specialty care to millions more Americans," Arora says, and rural providers can gain valuable treatment expertise.

Arora's goal is to establish an international network for managing HCV and other chronic care diseases. Project ECHO "can be replicated in developing countries, where non-physician clinicians can use the model to provide a very high level of care," he says.

For more information on Project ECHO, visit http://echo.unm.edu/index.html.