Gastroenterologists Nationwide Adopt Telehealth in Response to COVID-19, Study Reports

A nationwide survey of gastroenterologists and gastroenterology physician extenders conducted in May and June revealed an almost universal adoption of telehealth in GI practices and fellows’ clinics in the early months of COVID-19 in the U.S. The survey – one of the first of its kind – also pointed out limitations of telehealth for training GI fellows.

Survey findings were published in the journal Gastroenterology. Of the 230 GI providers who responded, 95 percent foresee a role for telehealth beyond the COVID-19 pandemic.

“I echo that sentiment,” said lead author Mohit Girotra, M.D., FACP, associate professor of clinical medicine in the Division of Gastroenterology and Hepatology at the University of Miami Miller School of Medicine. “Telehealth was already coming and COVID-19 accelerated the process of its adoption. But some issues need to be ironed out: video visits must be adequately reimbursed by payers and the platforms must be more patient-centric and HIPAA safe.”

For fellowship training programs, telehealth has presented significant barriers. “Fellows felt telehealth compromised their education,” Dr. Girotra said. “They couldn’t adequately shadow the attendings with telehealth and, in their own clinics, they found it difficult to follow their typical pattern of seeing/examining the patient, discussing the details with the preceptor attending, and then presenting a plan to the patient. One-third of responding fellows-in-training felt their education was compromised with adoption of telehealth.”

Dr. Girotra conceptualized the survey when “a lot of our patients were canceling their appointments, citing barriers,” he said. “We were wondering how telehealth was being adopted and utilized in other parts of the country. We wanted to know the barriers that patients were facing and to assess the overall impact on GI clinical practice.”

Survey findings from responding physicians, fellows and physician extenders included:

• Greater use of telemedicine (via phone only) in university settings while in-person visits were significantly higher in non-academic settings. Video visits were about the same in both settings.
• There were geographical differences as well, with the Northeast region reporting higher use of telemedicine (via phone).
• The patient’s preference of video or phone was dependent on the patient’s ability to use technology.
• Provider-perceived barriers to telehealth included technical issues with the platform/WiFi/Internet connectivity and lack of patient preparedness.
• 5 percent of respondents believe continuing telehealth could increase access to GI subspecialists.

“The study also signaled room for improvement when considering the educational needs of trainee physicians in the telehealth era,” said co-author Daniel A. Sussman, M.D., professor of clinical medicine in the Division of Gastroenterology and Hepatology at the Miller School.

Telehealth Potential

For the broader population of GI providers, Dr. Sussman said, “this study identified the willingness on the part of providers to continue telehealth services beyond the pandemic, recognizing the value of this platform in efficiently reaching isolated patients in medical need.”

While acknowledging telehealth’s potential in gastroenterology practices and clinics, Dr. Girotra points out the importance of maintaining in-person visits for a first patient visit.

“The first visit requires a physical exam and building a doctor-patient relationship,” he said. “Telehealth isn’t suitable for a new patient visit, but it’s a very strong tool in the field of GI for procedure follow-up and checkups for established long-term problems. For people who would have to drive many miles for a routine visit or to change medications, it’s an amazing platform.”

Regarding the use of telehealth for fellowship training, Tara Keihanian, M.D., gastroenterology fellow at the Miller School of Medicine, said, “With the current structure of these telehealth platforms, it’s hard to have three parties in the conversation. Improvements are required to allow the fellow to confer with the attending physician and for both the fellow and attending to address the patient within the context of one video appointment.”

In addition to Drs. Girotra, Sussman, and Keihanian, Prateek Sharma, M.D., a post-doctoral fellow in the Division of Surgical Oncology, also contributed to the study.

Tags: Dr. Daniel Sussman, Dr. Mohit Girotra, gastroenterology, telehealth