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.

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UrologistsCase load declines

by 30%*

Mid-level providers(NPs and PAs)

(Dev

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, ETS

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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

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es w

ou

ld b

e se

en

by

uro

logi

sts.

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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

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How Urology Remote Patient Monitoring (RPM) Works

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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

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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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