We talk a lot about innovation in health care and for good reasons. Technologies like artificial intelligence (AI), robotic process automation and large language models, combined with genetic testing, robotic engineering, and other innovations, promise to genuinely transform health care as we know it. The ultimate benefit is the ability to hyper-tailor care to the individual, known as “bespoke care,” as well as drive precision medicine.
Today, we apply industry best practices based on “a hypothetical ‘median patient.’” Bespoke care goes deeper and is much more complex, but at its foundation, it enables providers and patients to decide together what the best care looks like for that patient. Ideally, it’s a discussion that is not limited by parameters put in place by payers and health systems and includes all innovative options available.
If one of the ultimate benefits of innovation is bespoke care and precision medicine, taking a step back, I believe certain pain points drive innovation, globally in health care and specifically in gastroenterology. Some of these major pain points are access to care, cost of care and improving patient experience. If we look at our current state through the lens of these pain points, we will soon realize where and how we need to innovate, and which technologies will lead us into innovative, hyper-personalized and precise GI care.
The Need for Innovative Care
The American Gastroenterological Association (AGA) reports that between 60 and 70 million adults in the U.S. suffer from GI conditions. Research by the AGA indicates that 40 percent of those with GI issues say their conditions have caused them to avoid “routine activities” like exercising, running errands and spending time with friends and family. Unfortunately, a third of patients with GI problems won’t bring up their issues unless their doctor asks, which means their conditions are often more advanced when they’re found. This is especially unfortunate for those with colorectal cancer, where early detection is vital for optimal outcomes. What complicates the matter further is the challenge of patient access so even when patients are ready to speak with their providers, it is not always easy for them to get into the office.
As we look for ways to better engage patients in their GI care, we must remember that every patient is unique and deserves a more personalized approach. This is part of our effort to improve the patient experience. We must also keep access and cost in mind. Fortunately, our industry is replete with innovation right now — innovation that promises to help us deliver personalized care ideally in ways that improve access, reduce cost and improve the patient experience. Below is an example of just a handful of innovations that are already in use.
Real-Time Identification of Barrett’s Esophagus. Esophageal cancer is typically detected in an advanced stage when it’s difficult to treat. Many factors likely contribute to our delay in diagnosis, but one of our most important ways to combat esophageal adenocarcinoma is to screen for its precursor, Barrett’s esophagus. Our only option, until recently, was to scope, take samples and send them off to be evaluated. Of course, this remains the gold standard but if we go back to our pain points of access, cost and patient experience, innovations exist. Today, we have less invasive methods that may help us triage those who need endoscopy sooner but that still allows us to capture more patients with screening. One such method involves a device and biomarker test that uses a balloon that can be swallowed. The balloon collects a sampling of cells in the lower esophagus, which are then tested with a methylated DNA biomarker to detect Barrett’s esophagus risk. Research indicates that this innovative solution can deliver 90 percent sensitivity and specificity rates.
Innovative solutions like these enable us to proactively target particularly vulnerable populations. For example, firefighters have a 62 percent higher risk of esophageal cancer and a 39 percent greater risk of dying from the disease. Reaching out to firehouses to provide onsite testing is a great way to better personalize medicine, educate patients and improve outcomes for at-risk populations. This is innovation at its finest.
Innovation in Colon Cancer Screening. Going back to our pain points that drive innovation, the development of at-home solutions to detect colon cancer, like Cologuard, Colosense and Shield, are truly tackling the issues of access and patient experience. Colon cancer screening is the ultimate example in which lack of access can have significantly detrimental outcomes; currently, more than 50 million eligible adults in the United States are not getting screened. The lack of screening is multifactorial, but these noninvasive options should help increase screening rates. We also need to continue our education efforts on colon cancer screening along with reducing bowel preparation barriers (cost, taste) when it comes to colonoscopies. Abnormal results on any of the noninvasive screening modalities will result in a colonoscopy, and fortunately, we are also seeing innovation in colonoscopy technology. This is being primarily driven by AI and machine learning (ML).
Artificial Intelligence and Machine Learning. Health care has experienced an array of new solutions using AI and ML. These technologies have proven beneficial in the accurate “diagnosis, prognosis, and image analysis.” Since much of what we do regarding GI cancer detection involves imaging, AI and ML are bringing vast advances to our field. Machine learning is exceptional in the imaging space, as it can automate every frame, after which AI can conduct an initial diagnosis. The forefront example of AI and ML in GI currently may be CADe (computer-aided detection) of adenomas and precancerous polyps.
Genetic and Microbiome Analytics. Our guts are home to hundreds of species of microbiota, and the health of those microbial cells is linked to numerous diseases. The vast majority of GI diseases are related to an unhealthy or unbalanced microbiome. Microbiome-targeted therapies based on an analysis of an individual’s microbiome show promising results. GI specialists can use the information to create a customized guide for what an individual should or should not be eating. The information can also be used to develop hyper-personalized probiotics to help balance and heal an individual’s microbiome.
A recent study of fecal microbiomes across 8,200 individuals found “a shared common gut microbiome signature across unrelated diseases, including cancer, cardiovascular diseases, gastrointestinal diseases, neuropsychiatric conditions and other conditions such as skin problems and autoimmune disorders.”
A recent study of fecal microbiomes across 8,200 individuals found “a shared common gut microbiome signature across unrelated diseases, including cancer, cardiovascular diseases, gastrointestinal diseases, neuropsychiatric conditions and other conditions such as skin problems and autoimmune disorders.”
The handful of innovations mentioned above are just the beginning of creating more personalized GI care while also tackling the health care pain points of access, cost and patient experience.
The Future of GI Care Is Personal, Point of Care and Precise
Innovation in GI care has the potential to transform outcomes through more personal and targeted care. In addition to improving the patient experience, these innovations promise to reduce access issues and, ideally, cost. In the near future, more point-of-care testing will reduce patient wait times. Modalities such as in-office point-of-care lab tests and ultrasound will help determine the extent of a Crohn’s disease flare before the patient leaves your waiting room. And then there will be more fantastic and outlandish concepts like a remote-controlled pill camera that your patient will swallow that will help triage those who urgently need a complete upper endoscopy.
Embracing these innovations and implementing them in our practices will require a new mindset and a certain level of comfort with change. Our industry has typically been slow to change, driven in large part by our regulatory environment and significantly complex payment methodologies.
Regardless of these challenges, we must agree that this is an exciting time to be a GI physician. We are on the cusp of having new tools that will enable us to transform our patients’ lives. As long as we hold on to that vision, we can overcome barriers to change and make a real impact in our practices.
Neil D. Parikh, MD, is chair of the GI Alliance Innovation Committee, chief innovation officer at Connecticut GI and chief of gastroenterology at Hartford Hospital.