2015 American Journal of Gastroenterology Lecture

How Digital Health Will Transform Gastroenterology

Brennan Spiegel, MD, MSHS


Am J Gastroenterol. 2016;111(5):624-630. 

In This Article

Reaching Beyond the Four Walls

Take a look at the picture in Figure 1. This is where we deliver most of the health care in the United States and around the modern world. If you think about it, you will realize that this room is unusual. There is no other room in our lives that bears any resemblance to this room. It has a strange looking table–chair lined with tissue paper, bland walls, and a sink. It is impersonal and sterile. People do not want to come to this room.

Figure 1.

The modern examination room.

Most of our patients spend 99.9% of their lives far away from an examination room. People spend time at work, at home, in parks, at senior centers, and just about anywhere else but with us. Going to the doctor—whether to see a gastroenterologist or anyone else—is like going to the Department of Motor Vehicles. That is, you know you will get something out of it, but you will first sit in an impersonal waiting area while the rest of the world goes about its business; it can be awkward, sometimes inhospitable, and always comes with an opportunity cost.

If we are truly going to capture our patients' attention and engage them in their care, then we must reach beyond the four walls of the clinic, hospital, or endoscopy suite. We have to reach out to where our patients live, work, and play. We have to think outside of the (literal) box. This is the vision of the digital health movement—an effort to monitor patients remotely and dynamically with mobile health ("mHealth") smartphone applications, electronic health record (EHR) portals, social media, and wearable biosensors to improve health care outside of the clinical trenches.[1]

You will notice something else familiar about the picture that, as of yet, does not cleanly align with this optimistic vision of digital health. Right in the middle of the picture, emotionally and physically separating us from our patients, is the oft-maligned EHR. The EHR was originally designed to serve the transactional needs of administrators and billers, less so to support the therapeutic bond between patients and their health-care providers. Yet, for most doctors, the EHR is the only consistent evidence of a digital health revolution. The Affordable Care Act (ACA) included $30 billion to support health information technologies—principally the EHR—and the result is a computer in nearly every examination room in America. Nonetheless, the EHR can undermine the therapeutic bond, reduce provider satisfaction, and increase documentation requirements.[2–4] If we are going to enhance patient care, then we must also coax the EHR to do our bidding; it needs to benefit our patients and providers, not undermine the joy of medicine. Digital health innovators still have lots of work to do.

This article explores how advances in digital health may improve health-care delivery, focusing on gastroenterology and hepatology. It describes how technology can monitor patients remotely, improve face-to-face care, drive clinical decisions, and offer value to health-care organizations, their patients, and their staff. The article also describes some pitfalls and shortcomings of digital technologies and offers caveats for clinicians and their patients determining how to engage in digital health.

The article begins with a framework for how digital health allows clinicians to reach beyond the four walls to monitor patients. It then reviews major digital health technologies and provides examples of how they are being used in gastroenterology and hepatology to improve care, with a focus on evidence-based examples supported by peer-reviewed literature. The article concludes by describing a new model for how digital health can be deployed at scale to improve coordination and outcomes of care.