The Modern Era of Teledermatology

The use of telemedicine in various specialties continues to expand. In fact, telemedicine consultations are expected to reach 158 million per year by 2020, according to a report1 from the market intelligence firm Tractica. Telemedicine often fills a crucial gap in rural areas in the United States and in developing countries, where specialty physicians are lacking. As communication via messaging, apps, and video chat technology continues to emerge, telemedicine is also expanding into urban areas.

“Telehealth video consultations lend themselves to a wide variety of medical treatments,” said Charul Vyas, a principal analyst with Tractica, in a news release.1 “The flexibility and efficiency of video conferencing is helping healthcare providers and payers to achieve tangible value in deploying video-based patient monitoring solutions, both in terms of positive patient outcomes and cost savings.” 

As dermatologic care is primarily based on visual cues, teledermatology can be a valuable tool for clinicians and patients. 

Types of Teledermatology

Teledermatology in the United States has significantly evolved since the 1990s. Dermatologists began using this technology as a mechanism to provide specialized care to remote populations. However, in the 21st century, teledermatology has expanded to a variety of programs to meet the increasing demand for dermatologic expertise.2

The 3 main teledermatology care delivery platforms are synchronous (ie, video teleconferencing, real-time teledermatology), asynchronous (ie, store-and-forward), and hybrid (ie, mixed, having features of both synchronous and asynchronous forms).3

Synchronous platforms typically use live video conferencing between the patient and the teledermatologist. Asynchronous platforms use the store-and-forward technique, whereby clinical dermatologic images obtained by the requesting clinician or patient are stored and forwarded to the responding dermatologist, who can review the image and clinical history. The hybrid teledermatology platform combines live video teleconferencing and store-and-forward clinical images. This technique, however, is less commonly used, in part because it requires significant bandwidth and storage space and difficulty practicing across time zones.3

Practice Guidelines

In 2016, the American Telemedicine Association (ATA) published updated practice guidelines for teledermatology. In addition to delineating detailed clinical guidelines for the teledermatologic patient encounter and the coordination of remote patient care, the guidelines also outline technical specifications and recommendations to ensure the security and privacy of patient information. Furthermore, the guidelines describe limitations and challenges of teledermatology in certain clinical contexts or in examining particular areas of interest.3,4

table 1

The American Academy of Dermatology (AAD) also recently updated its position on teledermatology in a consensus statement.5 Although its key guidelines are similar to those outlined by ATA, the guidelines also underscore patients and referring physicians having a choice of the teledermatologist and access in advance to board certification qualifications of the clinician providing care. The guidelines emphasize maintaining the physician-patient relationship. For direct-to-patient dermatology, the AAD believes that the consulting dermatologist must either have an existing physician-patient relationship (having previously seen the patient in person), or create a physician-patient relationship through the use of a live-interactive face-to-face consultation before the use of store-and-forward technology, or be part of an integrated care delivery system in which the patient is enrolled.3,5 For practices considering adding a teledermatology service, the AAD has identified compliance issues that need to be addressed prior to implementation (Table 1).6  

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