Patients who need a diagnosis of the upper or lower gastrointestinal tract usually have to go to a hospital or clinic for a tube endoscopy. The capacity of these procedures is limited by infrastructure (rooms, endoscopes, etc.) and specialized staff (doctors, nurses, technicians, managers).
PROBLEM
Even without peer pressure from the pandemic, meeting needs can be expensive and often unavailable locally – especially in rural settings and those serving underprivileged communities. .
Dr Rome Jutabha, professor of clinical medicine, gastroenterology and hepatology, said: “Video capsule endoscopy offers an alternative test that can be performed in an outpatient, minimally invasive setting and can basically be scaled up and down pretty seamlessly”. Keck, and director, clinical outreach and development, USC’s Keck School of Medicine in Los Angeles, California.
“However, in a standard setting such as at USC or the neighboring Los Angeles County Hospital, after a GI consultation, the patient is still required to be present at the GI unit with a nurse present when the video capsule is swallowed and sometimes sometimes even had to stay at the hospital until the capsule was cleared out to return the equipment – the belt and the tape recorder,” he continued.
The technicians then need to download, compile and store the videos, which must then be analyzed by the doctors in a session that can last up to 90 minutes.
“Furthermore, rural health centers and community hospitals from California, Arizona, Nevada and beyond have reached out to USC asking for help in diagnosing GI when they don’t have any GI facilities, there is no capsule endoscope or no specialist who can conduct the procedure,” explains Jutabha.
“USC has turned to GI Digital, a company with a long history of providing capsule endoscopy and related technologies through its sister companies in Europe and Southeast Asia, to create the USC platform for GI through telehealth or ‘Tele-GI’,” he said.
“This solution is about establishing a platform that can bring other imaging technologies online – capsule endoscopy is the simplest solution for GI.”
Rome Jutabha, Keck Hospital and USC . School of Medicine
The goal is to drive a general shift in telehealth acceptance while implementing technology in GI. Before the pandemic, doctors, patients and insurance companies were really opposed to the adoption of telehealth. Then with COVID, suddenly most people accepted it.
“What we quickly learned was that patients liked it for a variety of well-known reasons – staying at home, avoiding travel efforts, limiting exposure to pathogens, less waiting time,” recalls Jutabha. more, etc.” “Doctors have to start telehealth but feel constrained because they cannot see patients in person and – especially during the height of the pandemic – cannot perform any procedure.
He continued: “This generates a huge amount of GI diagnoses that force them to take action. “Then, when the payers also agreed to pay for these telehealth diagnoses, we finally accepted capsule endoscopy through telehealth – or tele-GI .”
Now, the technology underlying the tele-GI is constantly improving, he added. Also, telemedicine visits are widely accepted, so it will certainly expand further from here,” he said.
SUGGESTIONS
During the pandemic, Keck Hospital and USC School of Medicine were unable to perform gastrointestinal screening for Barret’s disease, varicose veins, cirrhosis, colon polyps, and cancer.
Jutabha explains: “We cannot implement screening procedures without exposing employees to COVID. “What we want to do is do all the data collection, reporting, etc., remotely, followed by telemedicine.
“Those outcomes will then prioritize procedures for patients who need them most and tailor interventions accordingly,” he added.
Keck turned to GI Digital’s telehealth service for GI diagnostics, or tele-GI, combined with what the vendor calls a Tele-GI Smartbox, to support the four key components of the process. capsule endoscopy with telehealth: preoperative, procedure, post-procedural processing and reporting.
Jutabha explains: “While the Live Smartbox allows for process-related tasks to be performed with patients and paramedics directly with the patient using telehealth, video analytics and reporting using the software can called Tele-GI PEARL to support professionals working remotely”.
He continued: “All of the technology and services are unbelievable from the capsule supplier to ensure every choice our doctors, partners or patients make can be supported. “Furthermore, the entire teleworking process must be linked to existing telemedicine programs at USC, such as USC’s telemedicine – with provider Teladoc Health – and Powercharts. “
A virtual care committee oversees compliance with other regulatory and procedural requirements, and Biomedical Engineering ensures new capsule technology is introduced in a coordinated manner.
MARKET
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MEET CHALLENGES ONLY
Many administrative aspects must be addressed before the system can be fully operational at Keck Hospital and USC’s School of Medicine. This severely delays the execution.
“We chose a process that leads straight to standard care to avoid the pitfalls of abandoned telehealth projects,” notes Jutabha. “However, it also means more stakeholders are involved, more processes need to be followed, and some new processes are created and approved.
“With many of them unavailable due to the pressures of the pandemic, that means we’ve only just begun our first patient route with the hope of finishing our phase 1, which is taking place at USC campus in LA as well as neighboring LA County Hospital earlier this year and then quickly connected partner locations in Bear Valley, California and in Arizona to conduct up to 400 procedures by the summer of 2023. “
The core tele-GI team at USC and GI Digital has been leading since the early days of the project.
“It includes gastroenterology professors, residents and trainees; administrators; and nurses at USC, as well as business and technical leadership at GI Digital, including their service delivery manager.” “The project is funded by the head of the GI department.
He added: “While the current capsule endoscopy delivery teams are assessed on progress, we intentionally started by adding this solution to avoid any disruption to the procedure. standards, before anything is proven to be successful”.
In addition, the technology is referred to as “loosely coupled” by staff, meaning that any integration with existing systems is minimized in two of the first three stages, e.g. manual selection of steps. to upload reports or store videos to avoid the added complexity of an IT project.
However, data flows will be standardized to specify all requirements and can seamlessly start the work of IT integration and be ready for efficient delivery of standard care, Jutabha said.
“Furthermore, we are looking to use the ‘reader pool’ infrastructure to train more professionals and give young doctors the opportunity to learn about the process and step into the role of ‘reader’. read first'”, he explained.
RESULT
Telemedicine for patients with unclear gastrointestinal bleeding has become routine for Keck Hospital and USC School of Medicine. Staff have already begun with a small bowel examination where capsule endoscopy is the gold standard and are planning to move on to diagnostic tests of the esophagus, stomach, and rectum.
During the first quarter of 2023, our institution will receive approximately 100 patients through the new tele-GI infrastructure.
USE FCC AWARD FUNDS
The FCC’s telehealth grant program awarded Keck Hospital and USC Medical School $895,102.
“Existing telehealth solutions for radiology have been used successfully for many years and we can finally apply this innovation in GI,” sums up Jutabha. “This solution is about establishing a platform that can bring other imaging technologies online – capsule endoscopy is the simplest solution for GI.
“The bulk of the FCC’s funds have been allocated to purchase all infrastructure, software and equipment, set up, and train both delivery personnel as well as professionals – consistent with scope,” he concluded. defined vi of the project”. “The usual reimbursement will initially supplement implementation and then become a standard grant once the project has transitioned tele-GI to standard care.”
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