Telemedicine in Liver Disease and Beyond: Can the COVID‐19 Crisis Lead to Action?

Abstract

Evidence strongly supports that access to specialty gastroenterology or hepatology care in cirrhosis is associated with higher adherence to guideline-recommended care and improves clinical outcomes.Presently, only about one half of acute care hospitalizations for cirrhosis-related complications result in inpatient specialty care and the current hepatology workforce cannot meet the demand of patients with liver disease nationwide, particularly in less densely populated areas and in community-based practices not affiliated with academic centers. Telemedicine, defined as the delivery of health care services at a distance using electronic means for diagnosis and treatment, holds tremendous promise to increase access to broadly specialty care. The technology is cheap and easy to use, however, is presently limited in scale by interstate licensing restrictions and reimbursement barriers.The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Coronavirus Disease 2019 (COVID-19) has, in the short-term, accelerated the growth of telemedicine delivery as a public health and social distancing measure. Herein, we examine whether this public health crisis can accelerate the national conversation about broader adoption of telemedicine for routine medical care in non-crisis situations using a case series from our telehepatology program as a pragmatic example. Services.(1) Widespread transmission of the virus has reached pandemic proportions and is nowbeginning to cause disruptions in daily life in the United States. As part of the public health response, the Center for Medicare & Medicaid Services (CMS) and private payers are lifting restrictions on telemedicine reimbursement to facilitate healthcare access while minimizing the spread of infection.

Gastroenterologists and Patients Report High Satisfaction Rates With Telehealth Services During the Novel Coronavirus 2019 Pandemic

“…Of those seen for hepatic, biliary, and pancreatic disorders, 77.3% expressed willingness to use telehealth in the future, which did not meet the high satisfaction threshold of 80%. However, 86.4% of these patients indicated that their concerns were addressed by the provider, and this is consistent with the findings of a recent study by Serper et al 20 Patients seen for follow-up care, medication-related issues, and preprocedural appointments were particularly satisfied with their virtual visits. In these groups, telehealth is particularly effective because it is much more convenient for the patient and thus improves the overall care experience.…”

Use of Telemedicine and Virtual Care for Remote Treatment in Response to COVID-19 Pandemic

“…Furthermore, on March 6th, 2020, The Centers for Medicare & Medicaid Services (CMS) mentioned that it would temporarily pay physicians to provide telemedicine services for beneficiaries across US [9,14,[17][18][19][20]. CMS now allow medical-care providers to utilize devices such as smartphones and electronic devices to treat patients [15,16,[21][22][23]. Additionally, on March 17th, 2020 the U.S. Department of Health and Human Services Office for Civil Rights mentioned that during the COVID-19 health emergency, medical practitioners may telemedicine solutions [20], such as MyChart to support patient care [14,15,24].…”

Feasibility of telehealth in the management of autoimmune hepatitis before and during the COVID-19 pandemic

“…Few studies have been published in liver diseases [7]. Telemedicine has been used in HCV treatment and in the evaluation of patients with cirrhosis and hepatocellular carcinoma [11][12][13][14]. Two recent studies showed that telehealth was highly effective in the management of post-transplant patients and in identifying candidates for liver transplantation [15,16].…”