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This article appears in the Fall 2019 issue of the

PE GI Journal


The future of healthcare is digital, and mobile technology is an essential component.

In recent years in the U.S., the volume and complexity of endoscopic procedures have increased dramatically. An increasingly aging patient population, an emphasis on preventative care and surveillance, and new technologies for both diagnostic and interventional procedures have contributed to a growing demand for endoscopy.

In any setting, whether in a large-scale, tertiary-care hospital or a community ambulatory surgery center (ASC), there are significant challenges in operating endoscopy units. As we have seen in peer-reviewed GI journals such as GI Endoscopy and from private companies on the forefront of endoscopy center management, efficiency and optimizing workflow is crucial to practice growth and sustainability in the current GI landscape.


At the same time, the growth of the electronic health record (EHR) has allowed patients to access their healthcare at never-before-seen speeds and in unprecedented ways. This has created a force for innovation. This is transforming patient care into not just a medical necessity, but also a consumer product. Simply put, patients are still patients, but now they are also customers. They can shop around for their healthcare needs and want price transparency. They want access to their healthcare providers. Consumers want to consume health-related content at their convenience. They do not want to just take direction from their physician during a 15-minute appointment.

All of these forces have combined to create a new healthcare industry: Digital Health. The key concept of Digital Health is delivery of healthcare that is captured, measured, quantified and implemented in real time. This is done through the power of information technology. The field of gastroenterology has been greatly impacted by new advances in Digital Health. The impacts are mainly in two arenas: endoscopy center management and the patient experience.

Embracing Digital Health

Using Data to Improve Operational Performance

When it comes to the management of endoscopy centers, several peer-reviewed studies have searched for metrics for evaluating the efficiency of endoscopy units. These have included room turnover time, room-per-endoscopist ratio, usage of propofol anesthesia versus moderate sedation and True Completion Time (TCT).

One of the biggest challenges to developing lasting operational solutions, however, is obtaining actionable data that can be used for real-time analytics. Traditionally, administrative and clinical leaders have monthly or quarterly operations meetings to review performance and efficiency metrics as described above. In this approach, data from the previous time period (i.e., month or quarter) is collected and reviewed. Operational solutions are then implemented based on collective decision making. Sometimes, budget projections for the following fiscal year are even made on projections from prior data analysis.

What is fundamentally lacking in this approach, however, is the ability to analyze data and make decisions in real time. Our next great challenge as leaders is to ask,

“How do we learn from yesterday’s performance so that we can improve our unit workflow tomorrow?”

This is where the power of Digital Health can truly be harnessed. To date, mainstream EHRs have yet to develop tools such as mobile apps with user-friendly interfaces. These can automatically capture operational data, communicate across the entire care team and produce customizable reports at the tap of an icon.

By exploring partnerships with clinical and software innovators, gastroenterologists and practice managers alike can, and should, look to leverage information technology to elevate performance to new levels.

Reaching Patients Where They Are–Online 

As important as operational performance in the endoscopy center is, perhaps of even greater significance is the industrywide emphasis on the Patient Experience. The Patient Experience can be thought of as the range of interactions that patients have with the healthcare system, including their doctors, nurses and healthcare facilities. With increasing financial reimbursement tied to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, patient satisfaction and engagement are more crucial than ever.

The growing availability of digital media and content has impacted GI care delivery tremendously. Patients often research their gastrointestinal disorders extensively online even before referral to a GI specialist. Digital media outlets such as YouTube are becoming increasingly popular among GI practices in communicating essential information. These include endoscopic procedure animations and physician delivered tips for effective bowel preparation prior to the day of colonoscopy.

Moving Forward

Digital Health can be utilized to improve endoscopy center performance and create better outcomes on the day of procedure. Similarly, mobile app engagement tools can be leveraged to create a customized experience tailor-made for each patient. This must last from the time of initial office visit all the way through discharge after procedure. Automated reminders for appointment confirmation, bowel preparation compliance and educational content can put the patient at the forefront of GI care delivery. They now have access to their healthcare right at their fingertips.

As we move forward in our quest to deliver high quality care to our patients with GI disorders, Digital Health is the next frontier. Whether it is in optimizing workflow and operational efficiency in the endoscopy unit or providing patients with a bespoke experience in their GI care delivery, leveraging information technology is an essential tool for the success of the gastroenterology practice.


NEAL KAUSHAL, MD, MBA, is a gastroenterologist in Sonora, California. He is Chief of GI at Adventist Health Sonora and also serves as Medical Director of Ambulatory Care Services. Dr. Kaushal is also a well-recognized expert in endoscopy center efficiency and management. He is Chief Medical Officer of Core Mobile, Inc. This is a startup specializing in optimizing perioperative services. It aims to enhancethe patient experience via mobile technology. He can be reached at

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