Sharing the Wealth

With data security in mind and with the strong support of UNM Cancer Center Chief Medical Officer, Zoneddy Dayao, MD, Nir and the UNM Cancer Center HPB Team nurse navigator, Lynn Saavedra, turned to Project ECHO (Extension for Community Health Outcomes).

Project ECHO has perfected a telementoring model for doctors to learn and share knowledge about best practices in a virtual community of practice. Nir, Saavedra and their team of radiologists, medical oncologists, interventional radiologists and gastroenterologists worked with Project ECHO to successfully test the model with their established Presbyterian partners. They are now ready to expand the program to all cancer providers across the state.

“We are providing service line access for the management of HPB [hepatobiliary] cancers,” Nir says.

He explains that community doctors are highly valued because they provide a broad range of services, but they do not sub-specialize in treating rare diseases such as HPB cancers.

“Easy access to our multispecialty panel is imperative to first reach accurate diagnosis and then formulate the optimal care plan,” Nir says.

Nir is one of two HPB surgeons in New Mexico; the other is Matthew Hernandez, MD, who also practices at UNM Cancer Center. They, along with UNM HPB experts in medical oncology, diagnostic and interventional radiology, gastroenterology and clinical research, meet each week to review cases that are referred by community providers.

“The benefit [of this HPB-ECHO program] is that it provides a platform to allow community providers to share our expertise,” Nir says. “They can approach us from any remote location and have an in-depth clinical discussion with us.”

And just as important, he says, they don’t need to send their patients to UNM Cancer Center prematurely.

Using the ECHO Model, community providers can share a patient’s imaging results, lab testing results, and other information with the UNM Cancer Center HPB experts and get real-time feedback and recommendations. The whole panel can agree on a treatment plan and refer that patient to the appropriate subspecialty as needed.

Saavedra says that if the treatment plan calls for surgery or interventional radiology treatment or enrollment in a clinical trial — all appointments that the patient must attend in person at UNM — she facilitates the needed appointments for the patient in the meeting.

Before the HPB-ECHO program was in place, people diagnosed with HPB cancers would have to make appointments on their own, send their imaging and lab results to the UNM Cancer Center HPB team and then attend a consultation in person.

Any missing information meant that the trip to Albuquerque wasn’t as fruitful as it could have been and might have to be repeated.

The new program eases the burden on patients, Saavedra says. The only time they need to travel now is when they must get a treatment that cannot be provided in their own community.

UNM Cancer Center plans to extend the program to include other cancers and all New Mexico providers.

Itzhak Nir, MD, is a Professor and Chief of the Division of Hepato-Pancreatico-Biliary Surgery in the Department of Surgery at the UNM School of Medicine. He leads the Liver, Pancreas and Gallbladder Cancers Team at the UNM Comprehensive Cancer Center.

Lynn Saavedra, RN, MSN, OCN, is a Nurse Navigator and Program Coordinator for the Liver, Pancreas and Gallbladder Cancers Team at the UNM Comprehensive Cancer Center.

In addition to Nir and Saavedra, the hepato-pancreatico-biliary (HPB) multidisciplinary panel includes medical oncologists Ursa Brown-Glaberman, MD, and Erika Maestas, MD; surgical oncologist Matthew Hernandez, MD; radiologist Steven Eberhardt, MD; interventional radiologist Christopher Gutjahr, MD; and gastroenterologist Gulshan Parasher, MD.