Personalized Technologies in Chronic Gastrointestinal Disorders: Self-monitoring and Remote Sensor Technologies

With increased access to high-speed Internet and smartphone devices, patients have started to use mobile applications (apps) for various health needs. These mobile apps are now increasingly used in integration with telemedicine and wearables to support fitness, health education, symptom tracking, and collaborative disease management and care coordination. More recently, evidence (especially around remote patient monitoring) has started to build in some chronic diseases, and some of the digital health technologies have received approval from the Food and Drug Administration. With the changing healthcare landscape and push for value-based care, adoption of these digital health initiatives among providers is bound to increase. Although so far there is a dearth of published evidence about effectiveness of these apps in gastroenterology care, there are ongoing trials to determine whether remote patient monitoring can lead to improvement in process metrics or outcome metrics for patients with chronic gastrointestinal diseases.

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Private payer reimbursement for telemedicine services in the United States

Telemedicine has garnered significant attention over the past decade as a solution to cost and access challenges facing healthcare. Yet, utilization rates have not reached their full potential. One major barrier to the adoption of telemedicine cited in the literature is the lack of universal reimbursement from private payers. The purpose of this investigation was to capture a current picture of private reimbursement for telemedicine services in the United States. This investigation was a follow-up to a 2003 survey conducted by the American Telemedicine Association (ATA) and AMD Telemedicine. Representatives from 116 telemedicine programs were contacted between September and November 2005 via telephone and/or e-mail to participate in this survey. Of those contacted, we received responses from 64 organizations, a 55% response rate. To provide answers to our research questions, descriptive statistics were used for data analysis. Data indicate that the United States is progressing toward expanded private reimbursement for telemedicine services with 58% of responding organizations who provide potentially billable telemedicine services receiving private reimbursement (up 5% from 2003). In addition, it was found that 81% of those who receive private pay reported no differences between reimbursement for telemedicine services as compared to traditional faceto-face consults. Finally, of those who receive private pay, data indicated that telemedicine programs are submitting on average approximately 40% of consults for private reimbursement. While this investigation does suggest that we are making small improvements in private payer reimbursement, the change appears to lag behind a pace needed to optimize telemedicine deployment.

Addressing telehealth's foremost barrier: provider as initial gatekeeper

OBJECTIVES

During the past decade, telehealth has enjoyed a plethora of public funding and publication outlets around the world. Yet, rhetoric appears to be outpacing the actual diffusion and utilization of telehealth technologies for patient care. Several barriers, such as reimbursement and legal/regulatory issues, are commonly cited as impeding the successful deployment of this innovation. However, two separate studies carried out in Michigan that controlled for these barriers point out a more significant initial gatekeeper to the deployment of telehealth, namely providers.

METHODS

Multiple data collection strategies were used in both the telehospice and telepsychiatry projects, including utilization logs, surveys, telehospice nursing notes, cost frame data collection, patient interviews, caregiver interviews and focus groups, and videotaped visits.

RESULTS

This study summarizes data from the two studies to support the hypothesis that the provider is the most important initial gatekeeper for telemedicine.

CONCLUSIONS

The implications from this conclusion have important consequences for health system deployment strategies. Specifically, telemedicine project managers must keep providers' needs (ease of use and incentives) in mind when designing a telemedicine system.