Overcoming the Hurdles of Teledermatology

While many see telemedicine as the wave of the future, others are unsure of its place in the modern practice, due to a variety of legal and logistical hurdles. Some of those concerns are justified, but can be easily remedied or eliminated by choosing the right teledermatology partner and knowing what to expect. Here are 5 top concerns physicians face and how real practices have handled them.

1. Legal Considerations

If you already have malpractice insurance, when adding teledermatology to your practice, check with your insurance company to ensure that the new technology is covered. While this may seem like a time-consuming and potentially expensive process, figuring out the necessary steps can be as simple as a phone call, as David Herschthal, MD, found out.

“The knee-jerk reaction might be that the assumed risk is unknown [for your insurance provider], but they were quite familiar with teledermatology, and told me that they would handle it and that there would be no increase in premium,” said Dr Herschthal, who is in practice in Boca Raton and Fort Lauderdale, both in Florida.

Most states require that physicians be licensed in the state where their patients reside, and knowing whether or not you are eligible to treat a patient can be complicated.1 Whereas some software may allow a patient to contact you from any part of the country, the best teledermatology platforms will filter the patients whose needs and location best align with your practice and license(s).

2. Complex Setup

If teledermatology is meant to save physicians time and hassle, then it is important to look for a software that will make the transition quick and easy. Some qualities to look for:

  • How long will it take to download and get running? The initial setup should be seamless. The teledermatology companies should be able to accomplish this quickly, having you ready to see patients that same day.
  • What kind of support will you get? In order to maximize the value of your teledermatology solution, it will be important that key members of your staff are educated about the service and equipped with the tools to integrate it into their existing processes. Look for teledermatology partners that provide ongoing training and support and can guide you and your staff through this process.

3. Lack of Exposure

Once you have setup your practice with a teledermatology system, patients need to learn that it exists so they can use it. Instead of calling every patient, or casually mentioning it during a patient’s in-office visit, you can spread the word to both current and potential patients in several ways. A comprehensive teledermatology partner will provide guidance and support to help execute most if not all of these opportunities:

  • Send an e-mail to your patients alerting them that teledermatology is now an option, whether they need an initial consultation, want to schedule a follow-up, or need a refill for a prescription.
  • Place marketing materials in the waiting room or at check-in/check-out to increase the likelihood that your patients will register during or after an office visit.
  • Schedule patients for a virtual follow-up after an office visit. This is one of the best and most direct ways to introduce them to the service, assuming your teledermatology platform provides the necessary functionality.
  • Promote teledermatology on your website to appeal to the tech-savvy crowd doing their research. Dr Herschthal found that by showcasing his practice’s use of SkyMD on his homepage, patients were able to find and utilize the service much more easily.

4. Poor Photo Quality

The photo quality can make a big difference in a dermatologist’s ability to diagnose, making the fear of blurry or hard-to-interpret photos a valid concern for those looking to integrate teledermatology. However, as smartphone camera quality continues to improve, doctors said photo quality rarely impacts their ability to diagnose.2
There are always exceptions, and for the rare cases where a determination cannot be made from a digital photo, optimal teledermatology platforms will allow physicians the opportunity to request that the patient send a clearer photo, or come into the office for further evaluation.

5. Harm to the Patient Relationship

Teledermatology can appear, at first glance, like a much less personal way to deal with patients, especially returning patients who are used to seeing you face-to-face. This line of thinking assumes that all teledermatology does is replace an in-person visit. In many cases, however, the freedom to snap a photo at any time and receive a diagnosis without having to schedule an appointment—most likely during the workweek—has existing patients coming to their dermatologist more often through teledermatology because it more easily fits in their schedule.

“I originally thought that teledermatology would bring in mostly new patients, and while we’ve picked up some new patients, we’ve heard from a lot of patients that we haven’t seen in awhile because they weren’t able to get in,” said Steven Shapiro, MD, in practice in Palm Beach Gardens, FL. “We’re picking those patients back up because of teledermatology.”

In addition to fitting into the patient’s schedule much more easily, teledermatology software can also make it much easier for a dermatologist to provide a timely diagnosis.

“Some of our consultations come in on a Sunday night,” added Dr Shapiro. “Those tend to be the ones that cannot be seen during the week. They are so appreciative of a response from home on a Sunday night that many of them end up coming into the office and becoming very loyal patients.”

Furthermore, teledermatology provides an opportunity for doctors to check-in with patients for routine follow-up consultations to help eliminate redundant office visits. Debra Jaliman, MD, in practice in New York, NY, uses teledermatology to help her patients refill their prescriptions more conveniently. “If the patient cannot get into the office within the 6-month period, we can now, with teledermatology, give them the prescription refills,” said Dr Jaliman.

The Bottom Line

If you have only ever seen patients face-to-face in your practice, adding teledermatology may seem daunting at first glance. However, finding the right software company that will help you through every step of the process will enable you to overcome obstacles quickly and produce big returns for your practice.

Mr Price is the chief executive officer and cofounder of SkyMD, a telemedicine platform designed for dermatology. He developed SkyMD in collaboration with a team of board-certified dermatologists. He has previously led teams building innovative technology solutions across a wide range of industries. Mr Price holds an MBA from Harvard Business School and a BA from Harvard College.


References
1. Kocher R. Doctors without state borders: practicing across state lines. Health Affairs Blog. http://healthaffairs.org/blog/2014/02/18/doctors-without-state-borders-practicing-across-state-lines/. February 18, 2014. Accessed March 21, 2016.
2. Nami N, Massone C, Rubegni P, Cevenini G, Fimiani M, Hofmann-Wellenhof R. Concordance and time estimation of store-and-forward mobile teledermatology compared to classical face-to-face consultation. Acta Derm Venereol. 2015;95(1):35-39.