Establishing an Ambulatory Telemedicine Service in a Urology Practice

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Introduction: It is estimated that 75% of households in the United States have access to broadband Internet,1 of which, 81% of those utilizing internet services access online health information.2 As such, with the rising costs of healthcare, there has been a catalyzed interest in the development of efficient and effective healthcare delivery models.3 One such initiative has been the establishment of telemedicine.4–6 Specifically, in a urology practice, evidence suggests that ambulatory video-visits are well accepted by patients7 and provide a means for equivalent efficiency and satisfaction with significantly reduced patient-related costs.8 Herein then, we describe a step-by-step process for establishing an ambulatory telemedicine service in a urology practice. Materials and Methods: This video is a review of current literature with a step-by-step process to establish a telemedicine service within a urology practice. Results: Several unique considerations exist in establishing an effective telemedicine practice in urology. Modifiable features that may enhance patient acceptance include providing previsit education regarding the ability of the video-visits to deliver care equivalent to a traditional encounter and offering access to video-visit consultations in the presence of the patient's local referring provider. Patient technical considerations include access to broadband Internet, a smart mobile device, or personal computer, as well as speakers and a microphone. Minimum operating system requirements include Microsoft XP, Vista, or 7; or Apple OS 10.7 or greater. Accordingly, before implementing a telemedicine practice, it is important that the urologist ensures compliance with state-specific medical licensure, credentialing, and reimbursement laws. Specific physician technical considerations include the use of a secure, private, HIPAA-compliant licensed medical consultation software, providing supplemental patient education through a virtual platform and offering technical assistance when needed. For patient safety, the provider should identify and screen for indication-specific exclusion criteria, which may require a physical examination. Video-visits can be integrated into a traditional ambulatory clinic; however, to improve efficiency, we encourage the patient to perform a “test” call before their appointment and offer video-visits greater than 1 month before the anticipated visit to allow for patient accommodations. Conclusions: Establishing a telemedicine service in a urology practice is an effective and efficient way of delivering care to established patients while requiring minimal modifications to a traditional clinic model. Nevertheless, to establish a successful telemedicine practice, several important considerations do exist, including patient and provider technical requirements, compliance with state-specific telemedicine laws, and identifying patients in whom a physical examination can be safely omitted. No competing financial interests exist. Runtime of video: 5 mins 33 secs