Teleurology: Are virtual hospital consults feasible?

The COVID-19 pandemic has had wide-ranging effects on the practice of medicine. These include cancellations of in-office visits, surgery postponements or cancellations, social distancing in the office, and the explosion of telemedicine. As a result of the pandemic, the federal government has instituted emergency measures that lift restrictions on the use of telemedicine. This Urology Times® webinar, featuring experts in telemedicine, practice management, and coding and reimbursement, examines the impact this public health emergency has had on the practice-related aspects of urology and how urologists can prepare for the future once the emergency declaration is lifted. (To view the webinar in its entirety, see bit.ly/uttelemedwebinar.)

The panelists were moderator Jonathan Rubenstein, MD, chief compliance officer, Chesapeake Urology Associates, Towson, MD and clinical associate professor, department of surgery, University of Maryland School of Medicine, Baltimore; John Gore, MD, MS, professor of urology, University of Washington, Seattle; Aaron Spitz, MD, a urologist in private practice at Orange County Urology Associates, Laguna Hills, CA and assistant clinical professor of urology at the University of California, Irvine; and Eugene Rhee, MD, regional coordinating chief of urology at Kaiser Permanente Southern California.

In this segment, the panelists discuss urologists’ potential use of telemedicine for hospital consults.

Rubenstein: There are interprofessional consult codes and there are hospital telemedicine codes. Are you doing hospital consults from your offices to try and avoid going into a hospital setting on somebody who may not need a physical examination? Dr. Gore, is that something you’re doing at the University of Washington?

Gore: We are piloting it. I would say it has not become a regular part of our workflow. But we've prepared a process working with the ER for how to do it. We may be using it more in the next several weeks.

Rubenstein: Dr. Spitz, how about your experience with interprofessional consults or telemedicine visits for patients who are in the hospital?

Spitz: In private practice, we often do interprofessional consults, but we never charge for it nor have we been able to. This is something that I think our practice will look at more carefully because certainly there are occasions when we don't need to come in for a patient, even pre-COVID. Now, in the COVID environment, I am deliberately avoiding going into the hospital for consultations or even for rounds when a physical exam really is not required.

There are platforms that are HIPAA compliant. The InTouch robotic platform form is one such platform, but these platforms in my community are in limited locations-ER only, for example, not on the floors. What I have done for inpatient consultation as well as for inpatient rounding is to take advantage of the relaxation of the HIPAA requirements. The nurse who is caring for the patient will conduct FaceTime with me and the patient on her phone or his phone, or even on the patient's phone.

This has allowed me to avoid additional exposure to that patient. It has been a very efficient process and an easy process as well. In many of the consultations, even if you do have to go in and take care of a problem, such as an obstructed or infected stone, you don't necessarily have to see that patient in person before you schedule the procedure. With an examination demonstrated to you by a health care professional at the bedside, a face-to-face communication with the patient, and a review of the records and of the other diagnostic data that is accessible to you by remotely logging into the hospital EMR, the first time you need to drive in and enter that hospital grounds is to meet the patient in pre-op holding and perform the procedure.

Likewise, the next day, if the stent placement was straightforward, the patient's white count is going down, their fever curve is decreasing, and they are symptomatically doing well, there's really not a need to round on them in person that next day. It can be accomplished telemedically. These are just simple examples from my own personal experience, but it just demonstrates how we can incorporate telemedicine to the inpatient setting.

Rubenstein: Dr. Rhee, how about yourself?

Rhee: In our system, all of the hospitals have private rooms that are equipped with cameras and a huge widescreen TV, which allows the patient to be seen in what I call an integrated video visit. There is a common area in the hospital where consultants can actually do rounding telemedically through this integrated video visit through all the hospital rooms.

The other aspect of this in terms of the inpatient setting is the ER. In the ER, all of our physicians are equipped with iPhones that are compliant from an IT standpoint. These iPhones have been wonderful, whether for texting or for consultation on the phone or on video, to provide that access both for our emergent-ologists and our urgent-ologists.

Finally, in the operating room, in the inpatient setting, we have for the last several years really perfected an ability to do telesurgery, where a surgeon does not even have to be in a surgical OR, let's say with a patient who may be COVID positive to minimize exposure. There can be ways where a a surgical consultant can actually provide some of this care through a telesurgical means.