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TELEHEALTH FOR UROLOGY HAS ARRIVED
Remote patient monitoring, virtual video visits, and other technology… isn’t just a trend… but the very future of healthcare delivery in America. “This is going to become health care.”
– Dr. Neil Evans
Chief Officer Connected CareVeterans Administration
Appendix: Telehealth and UrologySupply and demand: We have to do something.
* ChildStats.gov US Census Bureau 1970 to 2017: 65 years and older
Supply will decline: 27% of urologists retire (next 5 years).
Demand will grow: 22% of population will be 65+ by 2040.
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The imbalance would hurt patients and providers.
Patients
• Longer waits
• Delayed treatments
• Lower satisfaction
Urologists
• Increased demands
• Burnout
Appendix: Telehealth and Urology
12% already tried it in 2018.
• 83% predict increased IoMT
(Internet of Medical Things) and RPM (remote monitoring) at their organizations within 3 years.*
*2018 The State of the Urology Workforce Census Book
And 91% of urologists are ready for telehealth.
Sourced from the Telehealth Index: Physician Survey 2019
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Here’s how it would work.
We create a focused urology-care pathway that allows mid-level providers at community-based clinics to:
1. Perform initial assessments on patients with urology complaints.
2. Manage uncomplicated cases locally.
3. Refer complicated cases requiring advanced
investigations and third-line therapies.
The Benefit: All prior investigations and treatment
results will be available at initial visit with urologist.
5
UrologistsCase load declines
by 30%*
Mid-level providers(NPs and PAs)
(Dev
elo
ped
in
co
llab
ora
tio
n w
ith
th
e A
mer
ican
Co
nti
nen
ce F
ou
nd
atio
n,
Van
der
bilt
Un
iver
sity
, ETS
O C
olle
ge o
f M
edic
ine
and
Cle
arTr
acTe
chn
olo
gies
)
Patientsw/urological complaints
1. Observation
2. First-line therapy
• Bladder training• Fluid management• Lifestyle changes
3. Second-line therapy
• OAB medications • BPH medications
Successful treatment (75%)
Efficiently arrive at suitable third-line therapy.
Proceed directly to invasive investigations
(e.g., urodynamics, cystoscopy), as needed.
1. Get urologic history.
2. Perform focused exam.
3. Conduct lab investigations.
• Urine culture if UA and UTI symptoms• Other tests (glucose, PSA) as necessary
4. Obtain objective voiding data.
• Uroflow and voiding diary (at home) • Post-void residual (PVR)
Complicated cases (60%)
Connected Care reduces urologists’ case loads by 30%.
Uncomplicated cases (40%)
Unsuccessful treatment (25%)
* C
om
plic
ated
(60%
) + u
nsu
cces
sfu
l (25
% o
f 40%
) =
70%
of t
ota
l cas
es w
ou
ld b
e se
en
by
uro
logi
sts.
6
Let’s consider the “uncomplicated case” pathway.
Mid-levels will be equipped with , a cost-effective and accurate void measurement service.
Before – (urologist only)• Uroflows – “I can’t go” or insufficient volume.*
• Voiding diaries – most are incomplete or inaccurate.*
*High Rates of Inadequate Urine Volume Cause Failure of Clinic Based Uroflowmetry in Men with Lower Urinary Tract SymptomsJason Chandrapal, Randy C. Bowen, Darshan P. Patel, Alvin Le, James M. Hotaling∗, Andrew W. Southwick
AUA Urology Practice Journal, July 2016 Volume 3, Issue 4, Pages 247–250
After – (mid-levels or urologist)• Uroflows – Go at home, naturally. • Diaries – automatically measured and uploaded.
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The CarePath® Precision Uroflowmeter
Durable handle for multiple use
Disposable bucket for single patient use
Durable handle for multiple use
Disposable bucket for single patient use
For women For men
8
How Urology Remote Patient Monitoring (RPM) Works
9
Your OfficeThe Cloud
The Device
The Phone• Enter fluid intake• Enter bladder leaks• Enter sleep• Enter voiding details
• Store data• Generate reports• Navigate patient records• Resupply and bill
• Provision devices• Reprocess devices• Bill patients• Print reports
Cellular
Uro
flo
w r
epo
rt
10
Initial 3-day voiding diary Voiding diary progress report
Your new voiding diary screens
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Next steps
We create a focused urology-care pathway.
1. Pilot the program in Tennessee and Colorado.
2. Perform clinical utility studies to assess outcomes.
3. Quantify the program impact on:
4. Roll out nationally
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• Veterans access to urology care
• Patient wait times
• Total cost for urology care
• Patient satisfaction
Improve geographic access to urology care for veterans
Reduce veteran wait times for urology consultations
Decrease the total cost of delivering urology care
Together we can:
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