Telehealth in Urology Beyond COVID-19

Abstract

Introduction: Implementation of telehealth (TH) accelerated during the COVID-19 pandemic and has become a vital part of health care delivery. As we move toward the post-COVID-19 era, clinical practice has demonstrated a need for updated policies and quality improvement to solidify the role of TH in the urology care setting. The AUA Census data were used to explore trends, benefits, and barriers to urology TH implementation. Methods: The AUA Workforce Workgroup and Telehealth Taskforce analyzed data from the 2019-2022 AUA Census. Pertinent variables included utilization, patient satisfaction, care settings, quality, and diagnoses amenable to TH. Results: Pre-COVID-19 TH utilization increased from 11.9% to 81% during and after the COVID-19 pandemic. TH is predominately used in metropolitan academic centers, with usage increasing from 12.8% to 83% in these areas during the pandemic. Usage also increased in non-metropolitan areas from 3.8% to 61.2%. Overall, 76.7% reported increased ease of scheduling follow-ups, 62% ease of ordering tests, and 69.5% ease of accessing patient data in favor of audio visits vs in-person visits. TH utilization increased from 42.4% to 65% for initial visits and 66.8% to 82% for follow-up visits. Over 80% of practicing urologists younger than 54 years desire the use of telemedicine for follow-up visits. TH increased patient access to care by 51.6%, and 54% of urologists expressed desire to continue using or increase utilization of TH. The top 3 barriers of patient’s ability to receive telemedicine were 67.6% noting lack of knowledge in using patient portal/software needed for telemedicine visits, 49.6% had lack of adequate conferencing tools, and 43.9% lacked high-speed internet service to enable video visits. In total, 53.4% of urologists would absolutely or probably increase usage if payment parity of TH was comparable with that of in-office E/M services. Conclusion: TH implementation accelerated during the COVID-19 era. In the post-COVID-19 era, TH continues to be important across multiple areas including patient and physician satisfaction and increasing access to care, particularly in rural areas. Barriers exist, especially concerning payment parity, and could be eliminated through advocacy for policy updates and standardization of technology.