Integration of telemedicine into clinical gastroenterology and hepatology practice
Two trends in health care delivery that will continue unabated are a) reimbursement pressure and b) increasing demand for our services. Practices that care for patients with complex and chronic conditions are exploring innovative means to expand their care footprint in an economically viable way. One approach currently being used by many health systems is telemedicine. Telemedicine is care delivered remotely using some type of electronic communication. Potentially, telemedicine will allow us to provide specialty services remotely to primary care physicians or even patients. The University of Michigan inflammatory bowel disease program is piloting remote video conferencing, integrated within the electronic medical record system, to provide specialty gastrointestinal consultation directly to Crohn’s and ulcerative colitis patients within their homes. The University of Michigan Health System has an office ready to arrange rapid teleconsultation for any provider. Payment for services has been secured from several payers after health system negotiations. This practice is well established in multiple specialties and settings. In this month’s column, two telemedicine experts review the state of the field, so you too can participate. This innovation is something you should consider for your practice. Technology and payment mechanisms are now available.
John I. Allen, MD, MBA, AGAF
Editor in Chief
As defined by the American Telemedicine Association (ATA), telemedicine is the exchange of medical information from one site to another via electronic communication to improve a patient’s clinical health status.1 If we include care provided over the telephone via providers and nurses between office visits, telemedicine has been practiced for decades. A recent study from the University of Pittsburgh documented 32,667 phone calls from 3,118 patients with inflammatory bowel disease (IBD) in 2010. Seventy-five percent of these calls were related to patient concerns or were generated by the nurse because of changes in the treatment plan.2 If these results are applied to a representative work week, busy IBD centers typically handle more than 100 phone calls per day.3 Telemedicine in clinical practice has expanded to include a variety of modalities such as two-way video, email, or secure messaging through electronic medical records systems, smartphones, wireless tools, and other forms of telecommunication technology (see Figure 1). The increase in use of telemedicine in practice has been driven by a number of factors.
First, it is almost universal that patients have access to a computer and/or cellular telephone. According to the Pew Research Center’s Internet and American Life Project, as of May 2013, 91% of adults are using cellphones.4 As patients have become more connected digitally, it is natural that they desire delivery of services, including health care services, electronically. Second, despite advances in medical, endoscopic, and surgical treatment, many patients still have suboptimal outcomes. There are many reasons for this, including but not limited to nonadherence, poor patient education, inadequate monitoring of symptoms and side effects, concurrent psychiatric disease, comorbid medical conditions, low self-efficacy, and limited access to health care; these issues can be addressed, at least in part, by telemedicine. Finally, patients are also seeking more efficient and convenient ways to receive their care,; including travel and wait times, an average office visit takes up to 2 hours.5
