Telemedicine for Lung Nodules

Additional Info

• Audio File:uab/ua142.mp3
• Doctors:Thachuthara-George, Joseph
• Featured Speaker:Joseph Thachuthara-George, MD
• CME Series:Medical Innovations
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=3839
• Guest Bio:Dr. George received his medical degree at St. John’s Medical College in Bangalore, India. He completed his internship and residency at the University of Texas Health Science Center and his pulmonary critical care fellowship at Baylor College of Medicine, both in Houston, TX. 
  
  Learn more about Joseph Thachuthara-George, MD 
  
  Release Date: April 20, 2020
  Expiration Date: April 20, 2023
  
  Disclosure Information:
  
  Dr. Thathuthara-George has no financial relationships related to the content of this activity to disclose. Also, no other speakers, planners or content reviewers have any relevant financial relationships to disclose.
  
  There is no commercial support for this activity
• Transcription:Melanie Cole: UAB Med Cast is an ongoing medical education podcast. The UAB division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category 1 credit. To collect credit, please visit UABmedicine.org/medcast and complete the episodes post-test.
  
  Introduction: Welcome to UAB Med Cast, a continuing education podcast for medical professionals bringing knowledge to your world. Here's Melanie Cole.
  
  Melanie Cole: Welcome. This is UAB Med Cast. I'm Melanie Cole and today we're discussing tele-medicine for lung nodules. Joining me is Dr. Joseph Thachuthara-George. He's an Interventional Pulmonologist and an Assistant Professor at UAB Medicine. Dr. George, it's a pleasure to have you join us today. Tell us about the UAB tele-medicine pilot project. How did this come about?
  
  Dr. Thachuthara-George: Thank you Melanie for having me. It's a pleasure to be on this Med Cast. Coming to our pilot project, our interventional pulmonary surveys see a lot of patients with lung nodules and suspected lung cancer. We see them in clinic for an initial visit at first, and then we plan on any diagnostic procedure if needed. Sometimes they may not need a procedure, and many of our patients live far away and have to drive a long way to come and see us just for this initial clinic visit. This cost them money, time and other resources. This made me think about using tele-medicine for this initial visit. So I approached Dr. Eric Wallace, who is the Director of tele-health at UAB. He helped me move this forward. Since this is a new concept, we decided to start this as a pilot project so that we can address all the flaws in the process before we expand it to more centers. So that's how all this came about and we started this project
  
  Host: Fascinating to me. So then tell us about the clinic at the BIB Medical Center. It's got a goal of, as you said, already seeing patients from the rural communities via tele-medicine. What's the long-term goal to expand this Doctor, and to other rural centers in the black belt?
  
  Dr. Thachuthara-George: So the goal, the main goal is to provide them with comprehensive care for diagnosis and staging before they are ready for treatment. And regarding the long-term goal of this initiative, we would like to expand to other rural centers in the black belt, as well as in the State, because I'm sure we will come across certain areas that we need to improve and it'll be much easier to do this on a smaller scale in this pilot project. Learn from our mistakes and then expand it to other centers, and the rest of the State
  
  Host: As I've done a few shows about tele-medicine from UAB specifically Doctor, in regarding the development of this project, speak a little bit about how long it took to develop those resources? You said you met with Dr. Wallace and you guys worked through this together and tried to figure out the kinks because they have already done some tele-medicine at UAB. What types of clinicians provided input? How did this all work out?
  
  Dr. Thachuthara-George: Yeah, so my main input has been from Dr. Wallace, who already has an established clinic for renal disease, at Bay Medical Center, as well as other medical centers. So he provided guidance and he took about a year to establish the clinic because not only that we needed to do, you know, things from our end. We also had to coordinate with people at Bibb County, the staff and as well as the management at Bibb County Medical Center. And they had been extremely cooperative and helpful in establishing this. And most of the time and effort, the delay in timing was mainly from my end because I had to do this during my spare time between my clinical work schedule. So that has been one of the things that kind of delayed things. But overall it took about a year for us to and then get this up and running. And our patients also, you know, there was a lot of input from the patients. That has been our main goal and driving force to start this project, too decrease their, to make it more efficient for them to come in and gain access to this service that we provide.
  
  Host: Well, that was going to be my next question. As far as the role of the patients in the development of the project. Tell us a little bit some examples of how you're using it for lung issues and nodules. Since some might be identified on radiographic studies and they need specialized follow-up to ensure early detection. Obviously tell us a little bit actually how you're using it. What's the procedure you're using?
  
  Dr. Thachuthara-George: Management of lung nodules as well as suspected lung cancer is a complex process. Any patient with a lung nodule always raises an alarm and all the patients from referring physician are concerned. So our job is first to re-stratify the lung nodule to determine the risk of this being a malignant nodule. So if the risk is low, then this can be monitored by a regular interval CT scan. If the risk of this being a cancer is high, then that requires next step. That is diagnosis and staging of the potential lung cancer. This often involves a procedure which is done by our interventional pulmonary team. And UAB is the only NCA recognized cancer center in the state. And we have an active multidisciplinary thoracic oncology team, which involves oncology, thoracic surgery, radiation oncology, radiology, pathology, as well as as interventional pulmonology. So once the patient diagnosis is made and staging is done, be coordinated with the rest of the specialists to plan the appropriate treatment for the patient. And some cases it'll be difficult to make a decision, which we discuss at our multidisciplinary, a tumor board meeting and plan the next step. So the tele-clinic basically enables the rural community to have access to this state-of-the-art guideline based management of their lung nodules and lung mass. And this will provide them easy access to this kind of service that is provided by UAB.
  
  Host: How have you seen this transform your decision making scenario? Can you tell us an interesting case or study where you've seen this really come into effect and work wonderfully?
  
  Dr. Thachuthara-George: First step in any of these patients is to see the patient asses them and plan on what needs to be done next. So sometimes we see patients who has significant medical comorbidities and who is not able to undergo any sort of treatment. So one example is when we see patients in clinic here at UAB, they come from far away and we see them in clinic, but they have significant medical comorbidities and they are not very functional. After we have a long discussion with the patient and the family, they decide not to undergo any treatment because, or any procedure because that might be of high risk for them. So in that case, you know, all these things can be done by a tele-clinic and counter, and they don't have to come all the way here driving three hours just for a clinic visit. So this kind of changes the initial management. We can bypass the initial encounter and if they really need to come here for a clinic visit or a procedure, we can bring them back for that particular reason. And this decreases the cost of a trip as well as, time constraints. This and benefits the patient that way.
  
  Host: So what about cost effectiveness then Dr. George? What about insurance implications? Obviously it would seem to be more cost effective and time manageable, more satisfying for patients, but what are the insurance implications? How's that working out for you?
  
  Dr. Thachuthara-George: So tele-clinic is covered by most of the insurance providers in the State as well as Medicare. And especially for the rural population, all of them covers it. So we, when we bill the insurance we just have to use a modifier and they cover it for the tele-clinic visit.
  
  Host: That's fantastic. So wrap it up for us, Dr. George, tell us about some of your long-term goals, what you've seen as far as functionality, how this works and how you're really decreasing patient wait time, expediting their diagnosis and staging process. How this is working so well for UAB medicine?
  
  Dr. Thachuthara-George: So when a primary care provider in Bibb County has a patient with lung nodule, they will contact the Bibb Medical Center, who gathers information and then contacts the UAB e-medicine team who will schedule the patient. By this time, we will have all the pertinent clinical information which we will review. So before we see the patient itself, we will come up with a rough plan for the next step and based on our pre-clinic review, the patient does have significant high risk for clinical lung cancer. Then we will also plan staging workup but at the same time so that we don't waste time. And then once we see the patient, we will schedule the patient. If the patient needs a procedure, we have to schedule them for a procedure here and during that visit we will try to coordinate other staging. Sometimes they need a pet scan or other imaging. We will coordinate to schedule that along the same time so that they don't have to make multiple trips. So that way we can try to organize everything within short time and have them ready for treatment.
  
  Host: What a great program. Thank you so much Dr. George for coming on today and telling us all about the tele-medicine pilot program for lung nodules at UAB medicine. And that concludes this episode of UAB Med Cast. A community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. You can also had to the website at UABmedicine.org/physician, for more information on resources available at UAB Medicine. Please remember to subscribe, rate, and review this podcast and all the other UAB podcasts. I'm Melanie Cole.
• Hosts:Melanie Cole, MS