The digital health space refers to the integration of technology and health care services to improve the overall quality of health care delivery. It encompasses a wide range of innovative and emerging technologies such as wearables, telehealth, artificial intelligence, mobile health, and electronic health records (EHRs). The digital health space offers numerous benefits such as improved patient outcomes, increased access to health care, reduced costs, and improved communication and collaboration between patients and health care providers. For example, patients can now monitor their vital signs such as blood pressure and glucose levels from home using wearable devices and share the data with their doctors in real-time. Telehealth technology allows patients to consult with their health care providers remotely without having to travel to the hospital, making health care more accessible, particularly in remote or rural areas. Artificial intelligence can be used to analyze vast amounts of patient data to identify patterns, predict outcomes, and provide personalized treatment recommendations. Overall, the digital health space is rapidly evolving, and the integration of technology in health

Sunday, May 17, 2020

Urologic Telehealth: Substitution or Expansion? Covid-19 and Beyond ?


Providers have had to adapt to using telehealth during a crisis, to. allow for distancing and improving office efficiency.   Most health insurers adapted quickly to the emergency needs.  I have not seen any reports regarding the rates of denials for telehealth as yet.  Will this carry forward after the emergency orders for distancing ?

Health insurers in the past have been reticent to offer telehealth visits as it has not been established whether telehealth increased health spending, or if it was offset by fewer in person visit. 



In a poster by 

Juan Andino, MD 

Michigan Medicine Department of Urology Ann Arbor, MI 

 While insurance companies are increasingly providing coverage for telehealth services, such as video visits, and healthcare providers are increasingly utilizing these modes of healthcare delivery, the impact of video visits on cost and quality is largely unknown. One important question is whether a video visit can serve as a substitute for in-person care or whether the use of video visits will lead to additional downstream in-person visits (i.e., expansion of healthcare utilization). 

Methods: We reviewed 141 consecutive, established patient video visits completed with four urologists at our institution. We then randomly sampled 141 established patient clinic visits to serve as our comparison group. After evaluating baseline demographics of the patients in the two groups, we determined whether video visits served as a substitute for in-person care or as an expansion of healthcare services, by comparing the number of additional visits (i.e., revisits) that occurred within 30 days of each type of encounter. 

Results: There was no difference in revisit rates after video visits (4%, n=6) compared to clinic visits (6%, n=9; p=0.42). Patients that were seen via video visits tended to be younger (54.9 vs 62.7 years, p<0.001). Differences in the distance from the hospital (72 vs 64.5 miles, p=0.65) and median income ($51,402 vs $53,239, p=0.46) were not statistically significant. The most common diagnoses evaluated through video visit encounters were urolithiasis (38%), kidney or upper tract malignancy (18%), followed by elevated PSA (10%), prostate cancer (7%), and voiding issues (7%). 

Conclusions: Video visits served as a substitute for traditional clinic visits and were used by patients with a broad range of urologic conditions. These findings suggest that the expansion of synchronous telemedicine coverage by private payers may not necessarily increase the utilization of healthcare services. 



This study was in a very limited cohort for one specialty, and may not reflect the overall effect of telehealth visits.  It was also performed during an acute crisis of a pandemic outbreak of a novel coronavirus.











































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