Teledermatology: Benefits and challenges

Telemedicine is a novel concept that continues to evolve at a rapid pace, but more and more dermatologists are adopting approaches and analyzing its affects. Session director Robert R. Stavert, MD, MBA, led a comprehensive discussion in his session on “Teledermatology” (U030).

There are two main models of teledermatology that dermatologists practice today, Dr. Stavert said.

  1. Store-and-forward (SAF): In this asynchronous model, patients provide medical history, relevant clinical data, and photographs, which are forwarded to a dermatologist who reviews the information and follows up with a consultation.
  2. Live interactive: In this face-to-face model, a patient has a real-time appointment with a dermatologist over a video platform.

The SAF model is more common and popular than the live model, said Dr. Stavert, because it is accessible, convenient, and doesn’t require as much technology. Teledermatology can be practiced in two ways. Direct-to-consumer occurs directly between a patient and teledermatologist. Provider-to-provider occurs when a patient communicates with his or her referring doctor, who then consults with a dermatologist.

In the session, Dr. Stavert and speakers outlined the benefits, risks, opportunities, and challenges of teledermatology.

Dr. Stavert: “Teledermatology platforms can provide significant benefits to patients and health care systems, but not all teledermatology services are created equally.”

Benefits and opportunities

  • Increased access, particularly in areas where geographic barriers prevent or limit a person’s ability to get dermatologic treatment
  • Increased convenience, particularly for patients who can avoid unnecessary visits
  • Reduced wait times for patients who need urgent consultation and for patients who need in-person visits
  • Improved scheduling, particularly in areas where dermatology services are in high demand
  • Lowered health care costs

Risks and challenges

  • HIPAA violations
  • Security breaches
  • Malpractice
  • Misdiagnosis, particularly due to incomplete history or poor photo quality
  • Misrepresentation of patients and their problems or of dermatology provider credentials
  • Reliable, high-quality technology
  • Reimbursement for services

In regard to the last challenge, Dr. Stavert said: “Reimbursement policies vary significantly from state to state and amongst payers. This heterogeneity can create confusion about reimbursement policies, and a lack of consistent reimbursement can deter provider or health care systems from implementing teledermatology services.”

Meeting technology standards and guaranteeing high-quality video consultations are also big challenges for dermatologists. The AAD has a Position Statement on Teledermatology supporting the care delivery method, which recommends that practices providing teledermatology also have a system to record the visit findings in the patient record, provide care coordination, and in-person follow-ups, as needed.

“Coordinating the different stakeholders in order to develop such a system can be a challenge,” said Dr. Stavert.

Putting it in practice

In addition to the benefits and risks, there are other things a practice or organization should consider before deciding to employ teledermatology services. First, they must assess their patient population, understand reimbursements, and confirm their malpractice coverage includes teledermatology services. Then, they must determine which teledermatology model would be more practical and successful to implement and maintain.

“Providers must also ensure that all the elements are in place to provide high-quality teledermatology for their patients, in accordance with the AAD recommendations,” said Dr. Stavert.

Teledermatology services that do not meet these recommendations can put patients at risk. Patients should be able to choose a preferred dermatologist, access a dermatologist’s credentials, and submit and receive the necessary medical information pertaining to their case.

Research shows that teledermatology, when designed and implemented correctly, can radically improve patient care and increase knowledge of the specialty, particularly among referring providers.

“Essentially, teledermatology platforms can provide significant benefits to patients and health care systems,” said Dr. Stavert, “but not all teledermatology services are created equally. It is important that the dermatology community continues to support systems that provide high-quality care, sustained by fair reimbursement, while deterring patients from utilizing services that are poorly designed and have the potential to cause harm.”

To learn more about teledermatology, visit the AADA’s Practice Management Center Teledermatology Toolkit. You can also read papers on sample implementations and its impact on the specialty.

 

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