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MedTech Outlook | Monday, October 03, 2022
It took telemedicine and telehealth some time to gain widespread acceptance in gastroenterology and liver disease.
FREMONT, CA: Coronavirus disease 2019 (COVID-19) has directly contributed to the exponential increase in the adoption and installation of telemedicine systems. As the number of vaccinated individuals rises and constraints loosen, patients, providers, health systems, payers, and governments will all play a role in determining the future of telemedicine. In the future, it will be crucial to use this black swan event to motivate beneficial health care reform. The future of telemedicine in the United States will depend on continued technological, reimbursement, and regulatory advancements, ensuring accessibility, quality, and convenience. The cognitive and procedural components of gastroenterology and hepatology are essential. The rapid deterioration of patients with cirrhosis may require an in-person evaluation, the management of chronic diseases, the psychosocial aspects of chronic liver disease, hepatic encephalopathy, and the need for caregivers, multidisciplinary care, and transplant evaluations. These factors necessitate considerable thought and metrics to evaluate which diseases and clinical settings warrant in-person review.
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Telehealth, eHealth, remote monitoring, and synchronous treatment are all included within telehealth, which is a more inclusive term that includes telemedicine, eHealth, and asynchronous treatment. The Health Resources and Services Administration defines telehealth as "the utilization of electronic information and communications technology to support and enhance long-distance clinical health care, patient and professional health-related education, public health and health administration."
According to the Federation of State Medical Boards, telemedicine involves "the practice of medicine by electronic communication, technology, or other means between a physician in one area and a patient in another with or without a healthcare provider intervening."
The World Health Organization defines eHealth as "the use of information and communication technology for health."
Health systems will also need to include telehealth instead of telemedicine as remote monitoring, and asynchronous communications become essential for care coordination. This momentum should not be squandered, as the COVID-19 public health emergency (PHE) has enabled rapid, large-scale innovation in telehealth.
Current State of Gastroenterology and Hepatology Telemedicine
Before the PHE, telemedicine was primarily limited to rural areas. The Centers for Medicare & Medicaid Services (CMS) reimbursed telemedicine services only for patients in rural areas if the services included interactive telecommunications with, at a minimum, audio, and video equipment and if the patient was located in a medical facility (originating site). As a result of the pandemic, waiver 1135 permitted exceptions to numerous rules that previously regulated telemedicine in the United States, extending services to regular health care to keep patients in their homes and prevent the spread of COVID-19. The originating site limitation was relaxed, allowing telemedicine to grow beyond rural areas and for patients to conduct virtual visits from their homes without having to drive to a health center. Most private payers approved the benefit, payment parity with in-person visits was given, interstate licensing limitations were loosened, and exceptions were provided to permit telephone conversation without visual equipment. In a national study of academic and community gastroenterology and hepatology providers, 87.9 percent reported utilizing telemedicine in their facilities greater than 75 percent, with more telemedicine being used in locations with greater COVID-19 prevalence and better technology access. As a result of the switch to telemedicine, trainees believed gastroenterology and hepatology education suffered. 95.2 percent of gastroenterologists acknowledged the value of telemedicine beyond the pandemic. In contrast, a multicenter study of gastroenterologists conducted earlier in the pandemic revealed that just 47 percent of centers had utilized telemedicine at a rate greater than 75 percent. A survey of liver and intestine transplant programs in the United States revealed that 75 percent of programs increased their usage of telemedicine from 16 percent to 98 percent after the pandemic began.
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