Using Telemedicine for Patient Encounters: One Urologist's Experience
Patients can be spared having to take off work and travel long distances for routine visits that do not require physical contact.
Eric M. Wallen, MD, Professor of Urology and Urology Residency Program Director at the University of North Carolina Chapel Hill, uses telemedicine for many of his routine patient encounters. He and his telemedicine patients connect through in live video appointments using a HIPAA-compliant app on their smartphones or tablets. He recently spoke with Renal & Urology News about his experience.
Why have you started using telemedicine to communicate with patients?
Dr. Wallen: My average patient travels over 2 hours to see me. If a patient has a combination of a long trip and a smartphone, you can save people so much time for a routine appointment. I offer it frequently to those kinds of patients. Many of them jump at the opportunity. It is so convenient to do a quick check-in with a patient this way.
How do you use telemedicine?
Dr. Wallen: I might start my clinic at 9:30 in the morning and have several telemedicine appointments starting at 8:30 via the TouchCare app I use. TouchCare is a secure video-based platform. A big concern with this type of technology is HIPAA regulations—which are very strict—and require a secure server. So I will have already touched base with several patients via telemedicine before I see patients who need to be physically present for appointments.
For me the best way to use telemedicine to set a block of time aside for telemedicine appointments—making it a regular part of my clinic schedule. That block can expand as I get more and more users. Because the visits are so efficient, this frees up time for me to see other types of patients instead.
Are such encounters reimbursable?
Dr. Wallen: They are frequently a reimbursable service. Both Medicare and Blue Cross/Blue Shield have worked on making guidelines, which are essentially a set of bullet points and documentation requirements that you have to fulfill that allows for billing. Billing can actually be done directly in the app that I use.
What are some of the more common patient encounters?
Dr. Wallen: One of the more common interactions I have with patients is a quick post-op check-in after a surgery. They use their smartphone camera to show me their incisions to make sure that they are healing fine. Another excellent use of telemedicine is for prostate cancer patient follow-up. Many patients have become relatively stable such that most of the appointment is taken up with a discussion of functional outcomes related to prostate cancer treatments, and a discussion of follow-up lab testing, which they'll often have done with their primary care doctor. They'll have their lab results for me or they will have sent them to me already, and then we just talk about their functional status for 5 or 10 minutes.
Do telemedicine encounters tend to be shorter than office visits?
Dr. Wallen: I suspect they are about the same in terms of my personal time interacting with them. But other potentially time-consuming parts of the encounter like check in, waiting room time, and nursing interactions are eliminated—all of which shorten the total encounter time. This is appealing in a patient-centered care approach as well as in terms of clinic efficiency.
What advice can you give to physicians who want to incorporate telemedicine into their practice?
Eric M. Wallen, MD, is Professor of Urology and Urology Residency Program Director at the University of North Carolina Chapel Hill
Dr. Wallen: The key is to be comfortable with using technology to interact with other people, and most of us do that daily in nearly every other aspect of our lives. But it is just beginning to become part of the doctor-patient interaction. Many physicians and patients are not quite ready to embrace that. For those who make the leap, it is phenomenally efficient. There's an online dashboard that the TouchCare app integrates with that helps with scheduling and managing appointments. Appointments can be back to back to back, without issues of getting patients into rooms, or cleaning rooms, all of the things that take time once a patient arrives at the office. That's not needed if the patient has an arranged window of time via telemedicine to connect with you, and in my experience both parties find the interaction to be satisfactory.