5 Key Trends in GI/Endoscopy
This article is sponsored by Endoscopy Division FUJIFILM Medical Systems U.S.A., Inc.
1. New technology in the field. Technology continues to evolve in several ways, according to Andrew Ross, MD, Section Chief, Gastroenterology and Medical Director, Therapeutic Endoscopy Center of Excellence, Virginia Mason Center, Seattle. One of the most important advances is the idea of "optical" histology.
"The concept is really using the endoscope and specialized accessories to make a tissue diagnosis without the need for a direct biopsy and histopathologic confirmation under the microscope," says Dr. Ross. "While this concept was introduced several years ago with the advent of technology such as 'FICE' and narrow band imaging, newer technologies such as confocal laser endomicroscopy really allow for visualization at the cellular level. Whether these devices will replace the need for true tissue biopsy remains a significant open question."
Another huge technological evolution for gastroenterology/endoscopy is minimally invasive surgical technique. Procedures once requiring open incisions and prolonged recovery times are now performed in endoscopy suites with less invasive procedures.
"The continued understanding of the submucosal space has allowed for the development and clinical implementation of procedures such as endoscopic submucosal dissection for the treatment of early-stage cancers of the GI tract and per-peroral endoscopic myotomy for patients with achalasia."
2. Proliferation of service agreements. More GI/endoscopy physicians are participating in multi-year service agreements with hospitals than in the past. These agreements should be carefully evaluated on individual merits and cost effectiveness.
"On the other hand, given the rapid pace that healthcare is likely to change over the next three to five years, locking into a fixed service agreement that does not change with technology or with economic pressures (that may come to bear on suppliers of those services) can work against you," says Barry Tanner, CEO of Physicians Endoscopy. "It is very much like airlines speculating on the future cost of fuel, depending on how much the market drives the price, it can either be a big win or very costly."
3. Appropriate cleaning, disinfection and sterilization. Cleaning, disinfection and sterilization is important for achieving good outcomes and quality service for patients.
"Consistent with professional organization guidelines including those from SGNA and federal agency recommendations (such as those described in the FDA/CDC/VA Safety Communication entitled Preventing Cross-Contamination in Endoscopy Processing issued November 2009), healthcare facilities should establish Quality Assurance and Safety Programs with an emphasis on endoscopy reprocessing," says Keith Nelson, Director, Infection Control and Product Development, Endoscopy Division FUJIFILM Medical Systems U.S.A., Inc. "They should also develop institutional Standard Operating Procedures for the reprocessing and storage of flexible endoscopes based upon device manufacturer's instructions."
Institutional quality assurance programs should include, but not be limited to:
• Identification of all staff involved in endoscope activities;
• Staff training;
• Annual competency review;
• Availability and dissemination of reprocessing procedures for all endoscopic equipment.
"Overall, we see that in facilities where strict adherence to training and education for dedicated cleaning, disinfection and sterilization exists, not only can additional efficiencies be found, but the frequency of product repair can also be reduced," says Kurt Cannon, Vice President, Sales, Marketing and Operations, Endoscopy Division FUJIFILM Medical Systems U.S.A., Inc.
4. Electronic data gathering. Physicians and ambulatory surgery centers are now looking to incorporate electronic systems, for electronic medical records or other software for data gathering, which are expensive and take time and energy to implement. However, the right system can have a big impact on performance measurement.
"You need coordinated EMR so you can pull together the results of all the procedures and compare it to the pathology outcome," says Michael Weinstein, MD, Vice President of Capital Digestive Care and Managing Partner for the Metropolitan Gastroenterology Group Division. "If you don't have electronic records then you are doing a lot of manual data collection."
When ASCs and physicians have their data gathered, they can benchmark against industry standards locally and nationwide to see how they measure up and locate areas of improvement based on the comparison.
5. GI Benchmarking. The payment system of the future is moving away from fee-for-service and moving toward a value-based methodology, according to Tom Deas Jr., MD, Medical Director of Fort Worth Endoscopy Center and Past President of American Society for Gastrointestinal Endoscopy. "If you are paying for value, you have to define and measure quality. We are going to develop more advanced and sophisticated ways of doing that and we are going to rely on information technology more. There will be electronic data warehouses for clinical and claims information that can be analyzed and studied to measure and assess quality performance.
"Then we can compare performance against guidelines and see whether physicians completed the guidelines appropriately. They must administer the right tests and medication for diseases and coordinate follow-up and blood work according to the protocols. It's fairly easy to take claims data and EHR data and determine if treatment was given in an automated way rather than doing chart searches to sort everything out.
"Additionally, we will begin to take this same approach for endoscopic operations. We will look at what it costs to provide various services and benchmark individual performance against others to determine whether we are achieving the highest level of efficiency for the resources spent."
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