2015 American Journal of Gastroenterology Lecture

How Digital Health Will Transform Gastroenterology

Brennan Spiegel, MD, MSHS

Disclosures

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

In This Article

The Future of Digital Health Monitoring

Integrating digital technologies into a harmonized health delivery model may improve process and outcomes of care. If used effectively, digital health monitoring may tailor care to individual patients, extend clinicians' reach outside of the hospital and clinic, improve timeliness and specificity of care, deliver proactive (not reactive) care, and better engage patients in their health.

Still, there are looming questions we need to answer: Who will be checking all of the data? How can doctors, who are busy in the clinical trenches, be responsible for monitoring and acting upon the data streaming off wearable sensors, social media, apps, and portals? Will clinicians get paid for all this extra work? Who has time for this?

The answers are simple: No doctor can sit around checking this data. Clinicians are too busy for this work. Plus, there is potential liability if a clinician misses key data and fails to act. Finally, doctors do not, as of now, get paid for any of this work. In short, digital health may sound terrific, but current structural realities make this vision untenable.

How do we move forward with digital health? I believe the answer lies in training a new type of specialist called the "Digitalist." The Digitalist does not yet exist, just as "The Hospitalist" did not exist prior to 1996, when Robert Wachter and Lee Goldman[27] coined the term to describe a much-needed clinician to fill an unmet need for inpatient care. Now we have an unmet need for a new clinician, trained in digital health, who will monitor, interpret, and act upon remote patient data. The Digitalist will reside in a digital coordination facility and remotely track data from biosensors, portals, apps, and social media and then combine the data with clinical parameters and knowledge about the patients' medical history. The Digitalist will bear responsibility for monitoring and acting on the data and will also be paid for the work in return for improving value and efficiency of care delivery, intercepting crises before they unfold, reducing avoidable admissions, and coordinating care with traditional providers in the clinic.

Figure 5 depicts this evolving model of health-care delivery. Patients will transmit actively and passively collected data through apps and portals. The Digitalist will monitor the data, and, if needed, contact the patient via EHR portal, telephone, or videoconferencing. If appropriate, the Digitalist will communicate directly with clinicians, inform them of updates, and coordinate the optimal timing of in-person visits. The clinician may also access digital health reports, review the results with the patient, and make further decisions based on the data coupled with the traditional history and physical examination.

Figure 5.

Model of digitally enhanced health-care delivery. In addition to traditional patient–provider communication and coordination, digital health affords new opportunities for remote monitoring of data, including patient-reported outcomes (PROs) actively reported through apps and portals, patient-reported informatics (PRIs) actively and passively collected by wearable biosensors and transmitted via wireless networks, and passive monitoring of social media data. The "Digitalist," residing in a coordination facility, monitors the data streams and directly communicates with patients via portals, telephone, or videoconferencing and then coordinates directly with clinicians as needed to manage patients.

If successful, digital health will expand care beyond the traditional clinic visit, use visits more effectively, reduce avoidable admissions, and improve outcomes of care. Time will tell if this future becomes reality, but for many health systems, the future has already arrived. Now is the time for gastroenterologists and hepatologists to shape the future of digital health for our field before others shape it for us.

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