Practice Management.

© 2018 by the AGA Institute 1542-3565/$36.00 https://doi.org/10.1016/j.cgh.2017.10.004 Telemedicine is defined broadly by the World Health Organization as the delivery of health care services at a distance using electronic means for “the diagnosis of treatment, and prevention of disease and injuries, research and evaluation, education of health care providers” to improve health. Although no single accepted definition exists, telehealth often is used as the umbrella term to encompass telemedicine (health care delivery) in addition to other activities such as education, research, health surveillance, and public health promotion. These various terms often are used interchangeably throughout the literature, leading to confusion. For the purpose of this review, we will use the term telemedicine to describe any care delivery model whereby patient care is provided at a distance using information technology such as cellphones, computers, or other electronic devices. Telemedicine through telephone and video technology has been used since the 1960s in the sectors of the military and space. Over the past several decades, as the use of wireless broadband technology has become more advanced and cell phone and internet use has become nearly ubiquitous, there has been a rapid emergence of technological modalities to facilitate health care delivery at a distance. The various forms of telemedicine currently in use are described in Table 1. Any of these can be provided as synchronous, such as a video teleconference with a clinician, or asynchronous/ store-and-forward, which may encompass review of prerecorded data such as clinical information through an electronic consultation, or of pathology and/or radiology images. In the United States, the use of telemedicine is increasing. According to a 2017 survey of 184 health care executives conducted by the American Telemedicine Association, 88% believed that they would invest in telehealth in the near future, 98% believed that it offered a competitive advantage, with the caveat that 71% believed that lack of coverage and payments were barriers to implementation. Recent studies have shown that telehealth interventions are effective at improving clinical outcomes and decreasing inpatient utilization, with good patient satisfaction in the areas of mental health and chronic disease management. The Veterans Administration (VA) has emerged as an early telehealth adopter in chronic disease settings such as mental health, dermatology, hypertension, heart failure, and, as of 2016, has provided care to nearly 700,000 (12%) Veterans since its inception. Despite the increased uptake, significant infrastructure and legal barriers to telemedicine remain and the literature regarding its utility in clinical practice continues to emerge. Compared with other chronic diseases (eg, heart failure, diabetes, mental illness) there is a dearth of literature on the use of telemedicine in liver disease. The first portion of this review synthesizes currently published literature of telemedicine/telehealth interventions to improve health care delivery and health outcomes in chronic liver disease including published peer-reviewed articles, abstracts, and ongoing clinical trials. The second portion discusses a framework for the future development of telemedicine and its integration into clinical practice by citing examples currently used throughout the country as well as ways to overcome implementation barriers.