Telemedicine and Its Role in Contemporary Urology Practice

Neil H. Baum, MD
Dr Baum is Professor of Clinical Urology, Tulane Medical School, and Principal, Neil Baum Urology, New Orleans, LA

Telemedicine will play a significant role in contemporary urologic practices. Although only a small percentage of urologists currently use this technology, many more practices are going to embrace it in the near future.1 Whether they realize it, most urologists already practice a form of telemedicine, such as taking phone calls from patients who ask for medication refills. In these cases, they have either acquiesced and called pharmacies to refill the prescriptions or denied the requests and suggested to patients that they make an appointment to receive a new prescription. The latter action probably does not endear physicians to their patients.

Urologists who give in to patients’ phone requests to have prescriptions filled or who offer free medical advice need to remember that they are not being compensated for providing those services. They should also keep in mind that they are likely motivating patients to continue to seek free medical advice without making follow-up appointments, which does not make for good medicine. This is where telemedicine can be an important adjunct to a urology practice. Physicians who use this technology can be compensated for time spent on the telephone with patients or communicating with them via virtual video visits because there is a record of these interactions.

In this article, which is the first of a 3-part series, we will discuss how urologists can implement telemedicine into their urology practices with minimal time, energy, effort, and expense. Subsequent articles will discuss legal concerns and how to properly code for telemedicine visits.

Application to Urology

Many patients do not require an in-person visit to the urology practice to receive effective care. Table 1 lists the types of urologic services that could conceivably be performed with telemedicine. There is even the potential to use telemedicine for postoperative visits.2

Practices typically use telemedicine platforms to manage the following 2 types of encounters: (1) walk-in visits through the practice’s website, in which patients are willing to be seen by the first available provider, and (2) appointment-based consultations, whereby patients schedule video chats in advance, usually with a specific physician. Although incorporating telemedicine into a practice may seem overwhelming, it is not as challenging as implementing an electronic medical record (EMR) system, as this requires training, purchasing expensive hardware and software, and the anticipation that production will be decreased until physicians, staff, and patients are comfortable with the new method of providing medical care. Telemedicine, however, is easy to implement, requires minimal additional equipment, easily interfaces with a practice’s website and EMR system, and will increase productivity and improve workflow. In addition, patients—particularly millennials—will appreciate the option of not having to travel for an appointment.

Most patients and referring physicians are already comfortable with their mobile phones and their digital devices, such as tablets and wearable technology (eg, Fitbits). So now is an opportune time to implement a telemedicine service.

Getting Started

Physicians and their staff first need to become comfortable with telemedicine technology. Physicians can begin by using video communication throughout their practice, such as hosting staff meetings using this technology. They should practice starting and ending calls and adjusting audio and video settings to ensure clear communication between the urologist and the patient. If physicians do not develop confidence in using video technology, they will not be able to use it effectively with patients.

To be sure, gaining confidence in front of a camera will involve a very short learning curve. It is common for physicians to experience some nervousness and anxiety. For example, a 5-minute presentation for patients on a urologic topic may require several practice sessions to feel at ease speaking with no audience to receive the message. It is easy to become comfortable during practice until the computer’s video camera is turned on. However, after 5 to 10 telemedicine visits, physicians will usually become comfortable in front of the camera.

Selecting a Video Platform

Table 2 provides a list of the most popular video providers and the advantages and disadvantages of each.

Table 3 lists free video chat apps.

Apps are available that can:

  • Easily share and mark-up laboratory tests, magnetic resonance images, and other medical documents without exposing the entire desktop
  • Securely send documents of a HIPAA-compliant video
  • Stream digital device images live while seeing patients’ faces.

Some practices rush into telemedicine even though their computers do not have cameras. Physicians need to take their time, do their research, and test out a few programs before selecting one for their practice. They should make sure their implementation team has the necessary equipment, including webcams, microphones, and speakers.

Practices should consider appointing a telemedicine point person who is knowledgeable about the new technology and can patiently explain it to other physicians in the practice. Urologists need to remember that video chat requires sufficient bandwidth and an Internet connection that is fast enough to handle a large amount of data, to ensure high-quality images. If a practice has connectivity problems, physicians should consider consulting an IT resource to ensure that all devices work properly.

Introducing Telemedicine to Patients

Once the core healthcare team is comfortable using video throughout a practice, it is time to test the technology with a few patients and perhaps a few payers. Most patients, especially the younger generations, are eager to start using video for their medical encounters. Physicians may also be surprised at how willing older patients are to have consults via video. According to a recent survey, 64% of patients are willing to see a physician over video.3 We think that this kind of communication will be even more attractive to younger patients who work full-time and do not have several hours for an in-office visit.

Physician colleagues, medical assistants, and nurse practitioners will also need to learn some basic telemedicine skills. Physicians and staff should strive to make video connections seamless for patients. Usually, patients need some guidance and encouragement, such as telling them to check their spam folder for invites if they do not see them in their e-mail inbox, adjusting the audio settings, or setting up their webcam. For the first video meeting with patients, urologists should make sure they build in plenty of buffer time for the unexpected, as certainly there will be some “bugs” that need to be worked out.

Urologists should observe and collect patient feedback regarding such questions as:

  • What kinds of devices (eg, laptop, mobile) do patients use?
  • What kind of networks are patients using (eg, 3G, corporate, home)?
  • What questions do patients ask?
  • What do they like or dislike about the video experience?

The take-home message is that urologists must have patience and be willing to hold patients’ hands as they become acclimated to a telemedicine consultation.

Telemedicine and Practice Workflow

Armed with feedback from patients’ video experiences, it is time to start streamlining online workflow. Most urologists want to be able to manage video visits similar to the way they manage face-to-face visits with patients. This may mean trying out a virtual waiting room. A virtual waiting room is a simple web page or link that can be sent to patients. On that page, patients simply sign in with minimal demographic information and select one of the time slots when the physician is available. Typically, these programs are designed to alert physicians and/or staff when a patient enters the virtual waiting room. Patients have access to the online patient queue and can start a chat or video call when both parties are ready. Such a waiting room model serves as a stepping-stone for new practices to familiarize themselves with video conferencing. This initial approach is advantageous and inexpensive for practices that already have a practice management system (PMS) and just want to add a video component to the EMR and PMS.

Telemedicine and Time Management

Telemedicine can improve the efficiency and productivity of a urology practice; however, good time management is crucial for success. A practice’s daily schedule and management of patients will need some adjustments, although significant alterations of existing schedules and workflow should not be necessary. Perhaps the best use of a urologist’s time is to schedule telemedicine appointments at the end of the day when the staff has left the office, because typically staff is not required for conducting a telemedicine visit. Ideally, physicians should offer a set time to communicate with patients to avoid making multiple calls to reach a patient. An advantage of telemedicine is that physicians can provide care in the evenings and weekends. Before telemedicine, physicians were taking calls from patients and giving advice and not being compensated for their time. Now a virtual visit can be easily conducted from any location and any computer or mobile phone and physicians can ethically receive remuneration for their services.

The Bottom Line

Patient-driven care is the future, and telemedicine will be part of that future. Patients want to have access to their healthcare providers without having to spend hours for a medical encounter that could be done in a few minutes via telemedicine. It is time to make the leap to incorporating telemedicine into clinical practices. It is not a question of if urologists will embrace telemedicine, but when they will include it as an effective communication tool.

References

  1. American Urological Association. The state of the urology workforce and practice in the United States, 2018. April 5, 2019. www.auanet.org/Documents/research/census/2018%20The%20State%20of%20the
    %20Urology%20Workforce%20Census%20Book.pdf. Accessed March 9, 2020.
  2. Viers BR, Lightner DJ, Rivera ME, et al. Efficiency, satisfaction, and costs for remote video visits following radical prostatectomy: a randomized controlled trial. Eur Urol. 2015;68:729-735.
  3. Gardner MR, Jenkins SM, O’Neil DA, et al. Perceptions of video-based appointments from the patient’s home: a patient survey. Telemed J E Health. 2015;21:281-285.

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