The University of New Mexico hepatobiliary ECHO: A scalable model for multidisciplinary cancer care.

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Background: Multidisciplinary team (MDT)-based care is widely recognized as a best practice in management of complex cancer cases; however, administrative, legal, and technological complexities – among others – have historically limited participation in MDT forums such as multidisciplinary tumor boards to clinicians within single, high-volume institutions. New Mexico is a predominantly rural state with substantial geographic and socioeconomic barriers to care. With only two specialists dedicated to hepatobiliary (HPB) cancers, the University of New Mexico Comprehensive Cancer Center (UNMCCC) sought to improve care coordination between its subspecialty clinicians and community-based oncology practices throughout the state by leveraging the Project ECHO (Extension for Community Health Outcomes) model. Methods: UNMCCC evaluated models for multidisciplinary, guided practice support and selected the ECHO Model, an evidence-based strategy that can support multidisciplinary co-management of complex diseases. This model was adapted to support MDT consultation through a pilot program focused on HPB malignancies. In February 2024, UNMCCC and the ECHO Institute at the University of New Mexico Health Sciences Center launched the UNM HPB ECHO with one community oncology site. The ECHO held weekly, 30-minute videoconferencing sessions and measured participation based on attendance and case presentation frequency. These sessions convened University-based surgeons, radiologists, pathologists, clinical navigators, and sub-specialty oncologists with community-based providers. Prior to each session, participating clinicians submitted patient imaging for review using a secure image-sharing platform. During sessions, the MDT conducted live, de-identified reviews of imaging and relevant diagnostic data to co-develop appropriate treatment and/or follow-up plans alongside participants. Results: Between February 2024 and January 2026, the ECHO held 55 sessions and facilitated 129 case consultations. Thirteen clinicians from the participating community oncology sites engaged in the program, with an average of two community-based providers attending each session. This assessment demonstrates the potential for improved coordination and navigation across multiple health systems, and for reduced patient visits in high-volume institutions. Sustained engagement throughout the pilot suggests that this MDT consultation for complex HPB cancer cases can be a valuable resource for community oncology providers operating in rural areas. Conclusions: This pilot demonstrated feasibility of multi-institutional collaboration and secure data sharing for highly specialized cancer care in community settings. Further evaluation is needed to assess the program’s impact on clinical decision-making, care delivery, and patient outcomes at participating sites.