Digital disruption


One of our lead articles stems from the annual Partners in Value meeting, which was developed by the AGA in partnership with the Digestive Health Physicians Association (Chicago, Oct. 4, 2019). This is an annual meeting about innovations and “what’s next” for GI practices. Anton Decker, MD, an expert in the business of GI and Chair of the Practice Management and Economics Committee, discussed “digital disruption.”

Dr. John I. Allen

When we discuss digital innovations in health care, most think of telehealth, social media, self-care apps, and remote patient monitoring. As a health system executive, my viewpoint about digital technology has been expanded by other critical needs. At the University of Michigan, we are space constrained (land locked without sufficient parking) and are living with shrinking clinical margins. We see digital technology as a solution to both. As we consolidate our call centers from 27 sites to 1, we plan for 30% of our staff to work from home. Setting up a home work station costs $3,000, compared with office space costs (about $5,000/year). A new clinical site might cost $20 million to build, but that is a fraction of the true life-cycle cost of the building. We have a widely distributed patient base (imagine traveling from Michigan’s Upper Penisula to Ann Arbor for a 20-minute clinic visit).

Many people appreciate “seeing” their doctor from the comfort of their living room. We plan to convert at least 15% of patient visits to telehealth over the next few years although reimbursement rules are still limiting. This year, more than 80% of postsurgical visits (90-day bundled payment) were conducted virtually – mostly by NPs or PAs. Our GI psychologist converted 1,500 patient visit hours to virtual visits last year. In 2019, we completed over 4,000 evisits (management of simple conditions initiated by a patient – essential during flu season) and an increasing number of econsults (primary consultations to specialists). Project ECHO (N Engl J Med. 2011;364:2199) remains the star example of how digital health can improve access, especially for underserved communities.

Virtual care, telehealth, remote patient monitoring, telecommuting and other digital innovations are becoming standards for health systems. Now is the time to think of “face-to-face” visits as option B.

John I. Allen, MD, MBD, AGAF
Editor in Chief

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