Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2019; 25(29): 3849-3856
Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.3849
Improving cirrhosis care: The potential for telemedicine and mobile health technologies
Matthew Jonathon Stotts, Justin Alexander Grischkan, Vandana Khungar
Matthew Jonathon Stotts, Vandana Khungar, Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
Justin Alexander Grischkan, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
Author contributions: Stotts MJ, Grischkan JA, and Khungar V all contributed to the literature review and the writing of this manuscript.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Vandana Khungar, MD, MSc, Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street 2 Dulles, Philadelphia, PA 19104, United States. vandana.khungar@pennmedicine.upenn.edu
Telephone: +1-312-3168415
Received: March 2, 2019
Peer-review started: March 2, 2019
First decision: May 16, 2019
Revised: June 14, 2019
Accepted: July 1, 2019
Article in press: July 3, 2019
Published online: August 7, 2019
Abstract

Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.

Keywords: Cirrhosis, Liver disease, Quality improvement, Telemedicine, Telemonitoring, Mobile health

Core tip: Telehealth and mobile health technologies have been used in other disease states with great success to reduce morbidity, mortality and cost while employing innovative design. Providers caring for patients with cirrhosis have not widely adopted these technologies but could benefit greatly from doing so. More resources need to be devoted to using innovative telemedicine strategies to improve the care of patients with liver disease. In turn, policy change will be necessary to allow all centers to implement these solutions in a cost-effective manner.