In a presentation at the 2022 Crohn’s and Colitis Congress, Fernando Velayos, MD, said that the concept of telehealth deals not only with clinical care, but rather is “the interaction of patient autonomy, consumer products, and digital advancement.”

Dr Velayos is the director of the Regional Program in Inflammatory Bowel Disease for Northern California Kaiser Permanente.

Since the beginning of the COVID-19 pandemic, providers and patients alike have become more aware of telehealth processes. With more experience, consumer and provider attitudes have improved toward these methods and technologies. There have also been certain regulatory changes in respect to licensing, prescribing, and billing that have made enacting telehealth easier.

Dr Velayos began by explaining the difference between the terms “telehealth” and “telemedicine.” While telemedicine refers only to clinical care at a distance, telehealth is a more inclusive term that can refer to both clinical and nonclinical services such as promotion of good health practices, preventive care, other reminders. Synchronous live videoconferences and asynchronous electronic communication—such as web portals to capture health information which is used later to evaluate a patient’s case—are telemedicine. Telehealth includes those 2 methods, as well as health data feeds, notifications, and reminders.

These other methods of telehealth make up “between-visit care,” as Dr Velayos called it—care that is generated between visits where information is either transmitted to the provider (such as with health data feeds), or to the patient (such as through notifications and reminders). This between-visit care is where Dr Velayos sees the greatest opportunity to expand telemedicine and telehealth from how they are now being used. “If you measure, monitor, and manage disease between visits, you can better identify who is at risk, prevent and uncover trends early, allow intervention, and improve outcomes,” Dr Velayos said. These methods of telehealth also allow more self-management for patients.

Sravanthi Parasa, MD, also spoke on digital health technologies, emphasizing that, with traditional visits, a provider only has access to certain intermittent data points. With digital health tools, such as sensors, platforms, and algorithms, providers can receive a more holistic view of the entire spectrum of the patient, gaining access to “invisible datapoints.” These tools use either data input by the patient themselves, or data gathered through a sensor, such as biochemical markers or stool analyses.

Dr Parasa is a gastroenterologist at Swedish Medical Center in Seattle, Washington.

Dr Parasa highlighted several of these more objective data sensors that are relevant to patients with inflammatory bowel disease (IBD). To monitor biomarkers, there are sweat-sensors, which detect biomarkers like interleukin 1 beta and C-reactive protein, through a patch or sensor on a watch-like device, as well as a wearable remote output monitor for an ostomy bag. This ostomy monitor also detects the output of fluid and ostomy site health digitally. In stool measurement, home-based fecal calprotectin tests use artificial intelligence to detect the degree of fecal calprotectin from a home assay. There is also some development in “smart toilets, that use images of the stool to determine the degree of inflammation and other fecal dynamics

Like Dr Velayos, Dr Parasa pointed out that digital health tools can improve a provider’s access to a patient’s life, allowing them to intervene sooner to optimize outcomes. She also noted that these technologies could improve public health because providers are able to identify the risk behaviors of the patient at home and better determine if they are compliant with medication, as well as delivering those timely interventions.

Dr Velayos also offered ways to think of the telemedicine as “more than just video visits,” such as using the web portal as an asynchronous health care visit. He suggested this could be enacted for evaluating straightforward problems, adjusting medication, and checking chronic disease. This kind of interaction could also be used in provider-to-provider situations, where a gastroenterologist could acquire a second opinion, or ask a specialist a clear question that does not necessarily require a full visit, by sending the patient’s chart through the portal.

Dr Parasa stated that these innovations also come with CPT codes to ensure reimbursement. She explained there are now codes for the collection/interpretation of physiological data, remote monitoring of a patient, supplying a device, and managing/monitoring a patient’s health.

In a meta-analysis that looked at various digital health platforms, researchers found that there was an overall reduction in health care utilization, a reduction in health care cost, and no negative impact on IBD disease activity, health-related quality of life, or treatment adherence.

There will always be a role for in-person visits, Dr Velayos assured. But as technology and testing advance, they present the opportunity for “telemedicine which goes beyond video visits to really move this technology from simply a substitute to a value-added, an improvement.” Dr Parasa echoed Dr Velayos’s call to action, saying, “I leave it up to your imagination as to how you can improve the care of your patients using digital health tools, technology, and artificial intelligence.”

—Allison Casey

Reference:

1. Parasa S. Digital health technologies for IBD care. Presented at: Crohn’s and Colitis Congress. January 21, 2022. Virtual.
2. Velayos F. Telehealth as clinical care pathway to improve population health in IBD. Presented at: Crohn’s and Colitis Congress. January 21, 2022. Virtual.