Quality teledermatology is part of the future for dermatology

Carrie L. Kovarik, MD

Dermatology has long been seen as the specialty that could best use telemedicine to treat more people and improve outcomes. Despite that promise, dermatologists are divided on the future of teledermatology at a time when they should be uniting to establish standards for its use, according to this year’s Livingood lecturer.

Carrie L. Kovarik, MD, a long-time leader in the development of teledermatology, used her Clarence S. Livingood, MD Award and Lectureship to try to get dermatologists on the same page to benefit patients and the specialty.

“There are people in the middle who see teledermatology as a good thing when it is used to provide quality care and improve access. Unfortunately, there are also people on one end of the spectrum who think this is a way to make a lot of money and sell products. Then there are people on the opposite end who are afraid that telemedicine is eventually going to take away their patients so they won’t have an in-person practice anymore,” Dr. Kovarik said in an interview about her lecture, “Telemedicine and the Future of Medicine.”

Sunday, her message to those on the opposite ends of the teledermatology spectrum was to broaden their narrow views and start focusing on the patients.

“We need to realize as a specialty that each member has an opportunity to be an example to the health care community, ensuring that we advocate or practice quality teledermatology that increases access to care in a way that is responsible and accountable to the patients we serve,” said Dr. Kovarik, an associate professor of dermatology at the University of Pennsylvania and an advisor to the AAD Telemedicine Task Force.

Access to care is more than having insurance, she said. It is about being able to receive quality diagnoses and treatment.

“Unfortunately, there are still dermatologists who don’t realize we have an access problem in this country,” Dr. Kovarik said. “People have to be able to reach a doctor. Teledermatology in many states has been shown to increase access if done in a quality way.

“Teledermatology can increase access, but it has to be done in the right way. That goes back to us as a specialty focusing on the fact that we have to keep the pillars of our specialty intact as we move forward with teledermatology.”

A misconception of teledermatology is that it mainly offers access to care for patients in rural areas, when it also has great potential for urban clinics to efficiently follow up with their patients. However, a threat to successful urban and rural models is teledermatology focused on profits, not patients.

“The cat is already out of the bag a little bit because there are other interests out there. We are in a capitalistic society, and they move fast,” Dr. Kovarik said. “We have businesses that have scaled-up teledermatology using non-dermatologists, telephone telemedicine, anonymous apps, and apps where the patients have to ‘self-diagnose.’ We can, as a specialty, stick to our principles and show how it can be done for our patients in a good, quality way.”

A key to quality teledermatology is for practices to use it in an appropriate manner in in their geographic area.

“It is important to have local groups practice telemedicine. For example, it is important that central Pennsylvania teledermatology is performed by someone in central Pennsylvania who understands the population and can actually follow up with those patients locally when required,” Dr. Kovarik said. “It would not be appropriate for me to get a license in Wisconsin and practice teledermatology there because I am not familiar with the patients, their medical issues, or local formularies, and I would not have a place for them to follow up in person if needed.”

Establishing a teledermatology practice does not require a major investment. Often, it can be done using existing infrastructure. It can be implemented within many electronic medical records using equipment most offices have, she said.

“Good teledermatology is not about technology and it’s not about money,” Dr. Kovarik said. “It is about providing our patients with good medicine, whether it is in our office or using technology. Technology-based medicine is going to happen, but it is about how we deal with it. We need to be a good example.

“We need to be responsible and accountable in how we deliver teledermatology. It has to be quality care, just like we would do in person. We do not hold teledermatology to a higher standard. It is the same standard as in-person care — the same ethics and the same standard of quality.”

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