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Should Your Practice Adopt Teledermatology?

Should Your Practice Adopt Teledermatology?

As of 2015, 62% of smartphone owners had used their phone to research a medical condition in the past year, and as one McKinsey report shows, 75% of patients would like to receive digital health care.1,2 Specifically, the report found patients are looking for more efficient care, clearer guidance, and access to a real person, should they have any questions. 

Though we generally talk about digital health care in grandiose terms, it does not have to be complex. With the right teledermatology partner, your practice can quickly begin offering established patients (and prospective patients) the virtual care they seek.

Although some providers may think they can avoid the growth of digital care, they would be hard-pressed to do so. Patients’ expectations around care are on the rise, with particular eagerness for value as well as communication and connectivity.3 As one book on the industry put it, “Health care is the largest service sector in many economies worldwide, but it lags behind other industries in the use of efficient and innovative approaches to both patient care and service organization.”4 

Teledermatology and Quality of Care

The 2 primary types of teledermatology are store-and-forward (photos and symptoms are submitted and reviewed asynchronously) and live-interactive dermatology (which, as the name suggests, involves a live consultation, much like a video conference). While live-interactive may seem like the more appealing option on the surface, it does not offer tangible improvements over store-and-forward consultations.5 In fact, any still camera will produce higher quality images than video will.

Not only do asynchronous, text- and image-based consultations perform just as well as live-interactive appointments, they can also be as effective as in-person visits.5 

One randomized trial found that “store-and-forward teledermatology did not result in a significant difference in clinical course at either of 2 post-referral time periods” compared with conventional consultations.6 

Additionally, store-and-forward teledermatology and conventional, clinic-based care offered comparable long-term clinical outcomes.7 These results are supported by numerous studies, which have consistently found concordance between digital and in-person diagnoses.8-10 A key element in the effectiveness of teledermatology is the quality of the photo, and ongoing improvements in smartphone camera quality will result in more effective teledermatology consultations.11 

Teledermatology may have an added impact on quality of care in 2 more key ways. It reduces patients’ wait times to see a physician, particularly in areas with fewer doctors, and reduces the cost of care.12-14 Insofar as these factors impact the efficiency and regularity of dermatological visits, it could have profound impacts on overall health outcomes. 

“I was initially concerned that patients would opt to connect virtually in lieu of scheduling an office visit but surprisingly instead it has been a tool that allows me to more efficiently triage care and actually open up appointment slots for patients who require procedures,” said Debra Price, MD, in practice in Miami, FL. 

As one study focused on cutaneous melanoma found, “teledermatology was shown to be accurate and reliable and able to significantly shorten the waiting periods for consultation with a dermatologist.”12 In one underserved, rural region, telemedicine was found to reduce patient loss due to rationing of physician access by 20%.13 

Also, as of 2014, 33% of consumers had put off medical care due to cost, according to a Gallup survey.15 Because teledermatology can reduce the cost of care, it can induce patients to consult with their dermatologist more regularly, yielding better outcomes.16,17 Add to this the enormous rates of medical noncompliance (caused, in part, by a lack of understanding of instructions), and it is clear that making physicians more accessible through teledermatology could significantly improve quality of care.18 

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Teledermatology’s Benefits 

There are a few applications for which teledermatology is particularly ideal. Managing chronic conditions, like psoriasis, through teledermatology may reduce the frequency of in-person visits, improve patient quality of life, and decrease costs.17,19 It has also been found to be an effective and efficient means of screening a lesion for skin cancer, due to the highly visual nature of the screening process.20,21 

Finally, it has proven to be a good means of managing consultations for issues like acne and aging.22 According to physicians who use SkyMD, a telemedicine platform designed for dermatology, about 2 out of 3 patients could be managed exclusively by teledermatology. 

Teledermatology can also help your practice attract new patients without having to accept a wider range of insurance plans or reduce the quality of care for existing patients. Offering prospective patients the option to initiate their first visit through a teledermatology platform can reduce the barrier for them to select you as their doctor and also give you a competitive advantage over other practices.

Of course, quantity does not always equal quality, and adding more patients and sacrificing care would be an unacceptable trade-off. Fortunately, patient satisfaction ratings for in-person and teledermatology are equivalent, with the added benefit of saving the patient time and money.16,23 In fact, patients appreciate the value of teledermatology, potentially building rather than diminishing patient loyalty over time. 

“You have the option [to use teledermatology] from the get-go when you’re referred to our practice,” said David Herschthal, MD, in practice in Boca Raton, FL. “Our patients are very comfortable with it…they are happy to be seen virtually.”

Teledermatology is a new, diversified revenue stream. Working with a teledermatology platform allows you to be compensated for the work you are often already doing (following-up on patient queries via e-mail or phone), while also consolidating any unavoidable back-and-forth into a secure, central, easy-to-use communication hub. Many teledermatology platforms also manage all the billing, dispersing payment reliably and regularly.

Finally, store-and-forward teledermatology is typically a more time efficient and convenient model for a dermatologist than a live-interactive or conventional visit. “I prefer a store-and-forward platform because I can review and respond to consults when it is convenient for me…when I have down time in my schedule,” said Dr. Price. 

In a store-and-forward model, you do not need to coordinate a specific time with the patient. Instead you can pickup these asynchronous visits at your convenience, with many providers using them to fill last minute gaps in their schedule due to a no-show or cancellation. In addition, a well-designed store-and-forward platform collects all the necessary data points from the patient up-front, eliminating the time you would normally spend gathering this information from the patient in real time.

Getting Started

Unlike large-scale electronic medical record integration, getting started with teledermatology is usually as lightweight as filling out a short online registration form.

“The transition [to SkyMD] took about 45 minutes,” said Dr. Herschthal. “If you consider yourself a state-of-the-art practice with state-of-the-art software and hardware and state-of-the-art procedures.…If you want to be in the vanguard of that group, teledermatology is a requirement, not a recommendation.” 

 

Mr. Price is the chief executive officer and co-founder 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. Smith. A. U.S. smartphone use in 2015. Pew Research Center. http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/. April 1, 2015. Accessed January 26, 2016.

2. Biesdorf S, Niedermann F. Healthcare’s digital future. http://www.mckinsey.com/insights/health_systems_and_services/healthcares_digital_future. July 2014. Accessed January 26, 2016.

3. Lateef F. Patient expectations and the paradigm shift of care in emergency medicine. J Emerg Trauma Shock. 2011;4(2):163-167. 

4. Jung C, Padman R. Disruptive digital innovation in healthcare delivery: The case for patient portals and online clinical consultations. In: Agarwal R, Selen W, Ross G, Green R, eds. The Handbook of Service Innovation. New York, NY: Springer; 2015:297-318.

5. Edison KE, Ward DS, Dyer JA, Lane W, Chance L, Hicks LL. Diagnosis, diagnostic confidence, and management concordance in live-interactive and store-and-forward teledermatology compared to in-person examination. Telemed J E Health. 2008;14(9):889-895. 

6. Whited JD, Warshaw EM, Kapur K, et al. Clinical course outcomes for store and forward teledermatology versus conventional consultation: a randomized trial. J Telemed Telecare. 2013;19(4):197-204.

7. Pak H, Triplett CA, Lindquist JH, Grambow SC, Whited JD. Store-and-forward teledermatology results in similar clinical outcomes to conventional clinic-based care. J Telemed Telecare. 2007;13(1):26-30. 

8. Bashshur RL, Shannon GW, Tejasvi T, Kvedar JC, Gates M. The empirical foundations of teledermatology: A review of the research evidence. Telemed J E Health. 2015;21(12): 953-979. 

9. Landow SM, MateusA, Korgavkar K, Nightingale D, Weinstock MA. Teledermatology: key factors associated with reducing face-to-face dermatology visits. J Am Acad Dermatol. 2014;71(3):570-576.

10. Weingast J, Scheibböck C, Wurm E, et al. A prospective study of mobile phones for dermatology in a clinical setting J Telemed Telecare. 2013;19(4): 213-218.

11. Nami N, Massone C, Rubegni P, et al. 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. 

12. Ferrándiz L, Ruiz-de-Casas A, Martin-Gutierrez FJ, et al. Effect of teledermatology on the prognosis of patients with cutaneous melanoma. Arch Dermatol. 2012;148(9):1025-1028. 

13. Berman M, Fenaughty A. Technology and managed care: patient benefits of telemedicine in a rural health care network. Health Econ. 2005;14(6):559-573. 

14. van der Heijden JP, de Keizer NF, Bos JD, Spuls PI, Witkamp L. Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. Br J Dermatol. 2011;165(5):1058-1065.

15. Riffkin R. Cost still a barrier between Americans and medical care. Gallup. http://www.gallup.com/poll/179774/cost-barrier-americans-medical-care.aspx. November 28, 2014. Accessed January 26, 2016.

16. Warshaw EM, Hillman, YJ, Greer NL, et al. Teledermatology for diagnosis and management of skin conditions: A systematic review. J Am Acad Dermatol. 2011;64(4):759-772.

17. Parsi K, Chambers C, Armstrong AW. Cost-effectiveness analysis of a patient-centered care model for management of psoriasis. J Am Acad Dermatol. 2012;66(4):563-570.

18. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304-314.

19. Frühauf J, Schwantzer G, Ambros-Rudolph CM,  et al. Pilot study on the acceptance of mobile teledermatology for the home monitoring of high-need patients with psoriasis. Australas J Dermatol. 2012;53(1):41-46. 

20. Lamel SA, Haldeman KM, Haines E, Kovarik CL, Pak H, Armstrong AW. Application of mobile teledermatology for skin cancer screening. J Am Acad Dermatol. 2012;67(4);576-581. 

21. Moreno-Ramirez D, Ferrandiz L. Skin cancer telemedicine. In: Soyer HP, Binder M, Smith AC, Wurm EMT, eds. Telemedicine in Dermatology. New York, NY: Springer; 2012:113-121. 

22. Frühauf J, Kröck S, Quehenberger F, et al. Mobile teledermatology helping patients control high-need acne: a randomized controlled trial. J Eur Acad Dermatol Venereol. 2015;29(5):919-924. 

23. Whited JD. Teledermatology. Medical Clinics of North America: Dermatology.  2015; 99(6):1167-1400.

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