Patients requiring upper or lower gastrointestinal diagnosis usually must come to a hospital or clinic for tube-based endoscopy. The capacity of these procedures is limited by infrastructure (rooms, endoscopes, etc.) and professional staff (doctors, nurses, technicians, administrators).
Even without the unparalleled pressures of the pandemic, meeting demand can be costly and often not available locally at all – especially in rural environments A place that serves underprivileged communities.
“Video capsule endoscopy offers an alternative examination that can be performed on an outpatient basis, is minimally invasive, and is essentially seamlessly scalable.” Director of Clinical Outreach and Development at .
“However, in standard facilities such as USC and nearby Los Angeles County Hospital, after a gastrointestinal consultation, patients are required to attend the gastrointestinal ward with a nurse present to swallow the video capsules. Sometimes we even have to stay, in the hospital until the capsule is excreted, and we return the belts and recorders and other equipment,” he continued.
The technician then has to download, edit and save the video. Then it should be analyzed by a doctor in a session that takes about 90 minutes.
“Additionally, local health centers and community hospitals in states such as California, Arizona, and Nevada contact USC to determine if there is no gastrointestinal equipment, no capsule endoscopy equipment, or no diagnostic specialist available. I was looking for help with a gastrointestinal diagnosis of . Please follow the steps,” explained Jutaba.
“USC turned to GI Digital, a company with a long history of providing capsule endoscopy services and related technology through sister companies in Europe and Southeast Asia, to launch GI’s USC platform through telemedicine, or ‘Tele-GI’. created. Said.
“The solution is to establish a platform that can bring other imaging techniques online. Capsule endoscopy was the easiest for GI.”
Dr. Rome Jutabha, Keck Hospital and School of Medicine of USC
The goal was to take advantage of the general change in telemedicine acceptance while deploying technology in the GI. Before the pandemic, doctors, patients and insurers showed real resistance to adopting telemedicine. Then with COVID, suddenly most people accepted it.
“What we quickly learned was that patients love it for a variety of well-known reasons: staying home, avoiding travel effort, limiting exposure to pathogens, waiting “They’ve had to start telemedicine, but they can’t see patients in person, especially at the height of the pandemic, so they can’t perform procedures,” Utaba recalled. I felt constrained by what I could not do.
“This increased the backlog of gastrointestinal diagnostics and forced them to act,” he continued. We eventually adopted telemedicine, or capsule endoscopy via remote GI.”
Now, he added, the technology underlying the TeleGI platform continues to improve. And with telemedicine visits being widely accepted, we’re sure to expand from here.
During the pandemic, Keck Hospital and the USC School of Medicine were unable to perform gastrointestinal screenings for Barrett’s disease, varicose veins, liver cirrhosis, colonic polyps, and cancer.
“We couldn’t do screening procedures without exposing our staff to COVID,” explained Jutabha. “What we wanted to do was do all the data acquisition, reporting, etc. remotely, followed by a telemedicine visit.
“These results will help us prioritize treatment of patients who need them most and adjust our interventions accordingly,” he added.
Keck uses GI Digital’s telemedicine service (tele-GI) to combine with what the vendor calls the Tele-GI Smartbox to perform four key telemedicine capsule endoscopy procedures. Support components. Follow-up and reporting.
“Smartbox enables telemedicine procedure-related tasks directly with patients and patient-facing medical staff, while video analysis and reporting can be performed remotely by specialists using software called Tele-GI PEARL. It makes our work easier,” explained Jutabha.
“All technology and services are capsule vendor agnostic to ensure that any choice a physician, partner or patient makes is supported,” he continued. “Additionally, the entire teleGI workflow should work with existing USC telemedicine programs, such as USC Telecare by the vendor, his Teladoc Health, and his Powercharts.”
A Virtual Care Board oversees compliance with legal and other procedural requirements and biomedical engineering ensures the coordinated introduction of new capsule technology.
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Responding to challenges
Many administrative aspects had to be worked out before the system was fully operational at Keck Hospital and USC School of Medicine. This significantly delayed the implementation.
“To avoid the pitfalls of an abandoned telemedicine project, we chose a process that leads directly to standard care,” said Jutabha. “But it also means more stakeholders are involved, more processes need to be followed, some newly created and subject to approval.
“We have just started our first patient pathway in hopes of completing Phase 1, as many of them are unavailable due to pandemic pressures, and will run at the USC campus in LA and neighboring LA.”2023 We will rapidly connect our partner sites in Bear Valley, California and Arizona to perform up to 400 surgeries by the summer of 2020.”
From day one of the project, the core Tele-GI team at USC and GI Digital has taken the lead.
“It is made up of GI Digital’s business and technical leadership, including gastroenterology professors, residents, interns, administrators, USC nurses, and service delivery managers,” said Jutabha. “This project is sponsored by the head of the GI department.
“While the current capsule endoscopy delivery team is being evaluated for progress, before everything is successful, we intentionally decided to make this solution complementary to avoid disrupting standard processes. I’ll start,” he added.
Also, the technology is what the staff calls “loosely coupled.” This means that integration with existing systems is minimal in her first two of the three phases. For example, uploading reports or archiving videos, opting for manual steps to avoid added complexity. of IT projects.
But with the data flow already standardized, Jutabha says all requirements can be specified and the IT integration effort can begin seamlessly, ready for efficient standard of care delivery.
“Additionally, we are considering using our ‘reader pool’ infrastructure to train more professionals and give young doctors the chance to learn about the procedure and step into the role of ‘advanced reader’.” he explained.
Telemedicine for patients with obscure gastrointestinal bleeding has become commonplace at Keck Hospital and USC School of Medicine. Staff will begin with small bowel examinations, where capsule endoscopy is the gold standard, and move on to diagnostic examinations of the esophagus, stomach, and colorectal.
Through the first quarter of 2023, the organization plans to see approximately 100 patients via its new remote GI infrastructure.
Use of FCC Award Funds
The FCC’s Telemedicine Grants Program awarded US$895,102 to Keck Hospital and School of Medicine.
“Existing telemedicine solutions for radiology have been in use for years already, and now we can finally bring this innovation to gastroenterology,” concludes Jutabha. “The solution is to establish a platform that can bring other imaging techniques online. Capsule endoscopy was the easiest for GI.
“The majority of FCC funding was allocated to acquire all infrastructure, software, equipment, setup and training of both delivery staff and professionals in line with the defined scope of the project,” it said. He concluded. “Regular reimbursement initially complements the rollout and becomes standard funding once the project transitions remote GI to standard care.”
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