As part of the AUA Institute for Business and Leadership offering, Teleurology: Practical Guide to Improve Patient Access to Urologic Care was presented in Chicago and is now available on demand. The practice of teleurology continues to evolve with progress in technology and policy. Teleurology encompasses many different forms from the now commonplace audio-only or synchronous audio-video outpatient visits to e-consults and mobile health applications. The terms telemedicine, telehealth, virtual care, digital health, e-health and m-health, and teleurology are used freely and sometimes interchangeably. They share a tripartite currency of people/communities, distance, and technology. While the modern era of teleurology/virtual care can easily be traced to the COVID-19 pandemic telemedicine boom, its origins date back decades to the invention of radio, telegraph, and telephone.^1,2 COVID-19 dictated social/physical distancing and telemedicine/teleurology offered quality care and access. The relaxation of billing restrictions with the public health emergency (PHE) declaration³ ignited rapid adoption and is now commonplace both in the US and worldwide.

The rapid adoption has led to significant research efforts to evaluate and optimize its clinical effectiveness. The growing body of literature in urology-specific telemedicine strongly supports its place in the urologist’s day-to-day practice. It has proven the ability to improve access, efficiency, and convenience of health care, but must be actively tailored to reduce barriers and build equity.^4-6 Continued outcomes evaluation and refinement of criteria for patient selection are needed to ensure safety and efficacy going forward.⁷ These data will come only with collaboration as in other fields of research. Some best practices (see Table)⁶ and “webside manner” were shared as desirable competencies in teleurology practice.

Table. Tips to Prepare Yourself and Your Environment

Arguably the biggest factor in teleurology expansion and future advancement is policy regulating allowable and billable practices. Urologists need to be aware of the patient-location-law approach, meaning the licensing rules and medical practice laws are based on the location of the patient at the time of the visit, not the clinician’s location.⁸ Additionally, urologists need to be mindful of state, federal, and, if applicable, international rules and regulations when designing a telemedicine offering. The PHE exemptions opened the door to several policies previously restricting widespread adoption, namely patient location, audio-only, and technology requirement restrictions.³ The end of the PHE declaration on May 11, 2023, brought back some restrictions, although few significant to urology until the end of 2023. It is imperative that the AUA joins forces to advocate for legislation to allow teleurology to remain commonplace for the benefit of our patients and our practices.

Designing a telemedicine offering in your practice can be a daunting task but can be broken down into simple steps. First is determining your top 2-3 goals in creating your telemedicine program. These should be selected based on your patients’ or communities’ needs, not based on the availability of a specific technology. With clear goals, you can select the target population and/or disease process to begin offering visits to. Just as with your in-person practice, scheduling, time management, charting, contingency plans, and infrastructure needs have to be planned out and rehearsed prior to going live. With the proper preparation, a rewarding teleurology practice is possible. There was a lively interactive session with the attendees contributing their ideas and experience, different scenarios—rural and remote communities of care, geriatrics, veterans, prisoners, and others. Adoption of telemedicine/teleurology in medical education and teaching curricula is bound to expand as technology-driven techniques offer new fronts in telementoring, telesurgery, and global health/surgery. We were reminded to be aware and culturally sensitive to the disparities that exist in age, educational status, rural and urban divide, access or lack of access to the Internet, and acceptable bandwidth. Some people in various communities cannot afford a capable smartphone to enable appropriate access to the burgeoning telemedicine/teleurology/virtual care offerings. As advocates for our patients, we must strive to enhance diversity, inclusivity, equity, and social accountability, promoting and providing hybrid care (“virtual” and “face to face”) as desirable and appropriate. Let us set simple, achievable goals toward digital health in teleurology worldwide as we advance to 2025 with the WHO!^4,10

Please feel free to reach out with questions, and we look forward to seeing you again in San Antonio.