Using Telehealth to Reimagine Digestive Disease Care

Ella Sanman, ARNP, discusses care with a patient via telehealth.
Ella Sanman, ARNP, discusses care with a patient via telehealth.

Even before the COVID-19 pandemic, the Therapeutic Endoscopy Center of Excellence had launched virtual visits, including pre-procedural consultations and follow-up appointments for patients with digestive health concerns. This innovation enabled patients to benefit from the team’s expertise and positioned the Digestive Disease Institute to quickly expand telehealth capabilities during COVID-19.

“When COVID-19 interrupted in-person care, telehealth gave us a glimpse of what the future of patient-centered healthcare could and should be,” says Karen Gifford, Senior Director who lead the swift expansion of telehealth. “We’ve seized this opportunity to reimagine care in ways that use telehealth to make care better and more convenient for our patients.”

Prior to the pandemic, approximately one percent of visits in the gastroenterology clinic of the Digestive Disease Institute were conducted via telehealth. That number increased to 20.2 percent from March through August of this year, enabling identification of opportunities to expand long-term utilization of telehealth such as on-demand multidisciplinary virtual care for complex patients and accelerated intake and evaluation of urgent referrals.

Accelerating Care for Urgent Referrals

As one of the region’s largest referral centers, the Therapeutic Endoscopy Center of Excellence typically receives 400 to 450 referrals to Virginia Mason per month from outside providers. Telehealth is being used to reduce the time from urgent referral to first appointment.

“Our goal is to use virtual visits to quickly intake the patient, evaluate the case, and decide on a treatment plan, so we’re ready to perform the needed procedure as soon as possible,” says Andrew Ross, MD.

In addition to improving access across a much larger geographical area, telehealth enables Virginia Mason to extend its circle of support and education to other hospitals.

To achieve this goal, Advanced Practice Providers such as Ella Sanman, ARNP, who spearheaded the Center’s telehealth initiative before COVID-19, conduct virtual consultations with new patients within a week of referral, and sometimes within 24 hours. Additional tests and imaging are reviewed by the endoscopist, who then may conduct an additional in-person or virtual visit with the patient if needed.

The emphasis on virtual care is especially beneficial to the significant percentage of patients who live more than 100 miles away, with many patients traveling from as far away as Alaska or Hawaii. While the number of virtual visits across Virginia Mason peaked in April, they continue at levels two to three times higher than pre-pandemic levels.

“Care team members can talk a patient through their options, answer questions, and decide on an appropriate plan, so faraway patients won’t have to come to our Seattle campus until it’s time for their procedure,” says Rebecca Okelo, Director of Gastroenterology. “We’re aiming for this approach to be our new model of care.”

Multidisciplinary Virtual Care

Virginia Mason’s telehealth platform, InTouch, allows multidisciplinary providers in different locations to be involved in a single patient visit and is also being used in the Digestive Disease Institute to conduct multidisciplinary tumor boards.

Val Simianu, MD, colorectal surgeon specializing in cancer surgery invites other surgeons — such as Scott Helton, MD, HPB surgeon — to a patient visit to facilitate multidisciplinary collaboration.

“Almost everything I do lends itself to multidisciplinary care, and telehealth makes it easier to quickly deliver that high-quality care in a way that is much more convenient to patients,” Dr. Simianu says. “We fully expect it to be a new model of care moving forward.”

The vision is to provide on-demand, multidisciplinary virtual care to complex patients across the Digestive Disease Institute every day. The pandemic has accelerated the effort!