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Telemedicine: Consider Your Platform

Telemedicine: Consider Your Platform

Fri, 04/17/2020 - 14:57

April Armstrong, MD, MPHWe’re living in unprecedented times right now. A few months back, telemedicine was generally confined to the context of research into its efficacy as a health care delivery modality and a possible adjunct to care for our existing patients.1 At that time, I don’t think we could have ever anticipated what is currently happening in the world. Since then, telemedicine has been thrusted into the forefront of health care delivery for many of our dermatology patients.

It is important that we are nimble to use different models of teledermatology delivery, including live interactive and store-and-forward methods, and that we recognize that different patient populations may be receptive to different types of delivery. For example, patients who can see their provider through web-based, video-based teledermatology tend to be more satisfied with their encounter. This is probably because patients enjoy having direct interactions with the dermatologist and having their questions answered in real time. However, as we know, the quality of a teledermatology appointment can vary greatly depending on the lighting, internet speed, and experience of the patient in terms of capturing their skin lesions through the video feed. Therefore, in those instances, it is important to provide patients a method of sending photographs, which oftentimes can be of higher quality, to supplement the live interactive telemedicine session.

Another factor to consider is the efficiency of your practice, which can be vastly different for each dermatologist and even from patient to patient. For example, for some patients you may be answering their questions over asynchronous telemedicine with attached photographs. Perhaps there is a lot of back and forth between you and the patient; a prolonged conversation could be addressed easier through a live interactive telemedicine encounter. Therefore, while some practices need to put in the effort to schedule those live interactive telemedicine cases rather than an asynchronous session, from the patient perspective, more immediate satisfaction can be achieved through the live interactive arm of telemedicine.

One other aspect I want to mention is reimbursement. As we know, the Centers for Medicare & Medicaid Services has enabled reimbursement of telemedicine under certain circumstances,2 and the rules and regulations are changing rapidly. It is critical to be up to date on those regulations. I recommend that dermatologists visit the American Academy of Dermatology website to obtain a continually updated synopsis of the recent changes.3

As a specialty, dermatology should advocate for robust reimbursement for telemedicine visits, whether synchronous or asynchronous. It takes just as much effort, time, and energy to carefully diagnose and manage patients through telemedicine as it does in person. Therefore, I believe reimbursement for telemedicine should be held to similar footing as in-person visits.

Dr Armstrong is associate dean for clinical research and professor of dermatology at the Keck School of Medicine and the study’s principal investigator. Dr Armstrong also sees patients as a dermatologist with Keck Medicine of USC.

Editor’s note: This piece is based on a video interview with Dr Armstrong conducted in early April 2020. View more expert insights on


  1. Mateja L. Teledermatology: an answer to managing chronic skin diseases? The Dermatologist. 2020;28(2):36-39. Accessed April 14, 2020.
  2. Medicare telemedicine health care provider fact sheet. Centers for Medicare & Medicaid Services. March 17, 2020. Accessed April 14, 2020.
  3. COVID-19: teledermatology. American Academy of Dermatology. April 15, 2020. Accessed April 15, 2020.
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