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Jonathan Cotliar, MD, on Telemedicine for Dermatology

Jonathan Cotliar, MD, Chief Medical Officer of Science 37, offers his thoughts on telemedicine and tips for dermatologists looking to implement a virtual component into their practice. Watch Dr Cotliar discuss how COVID-19 has changed virtual trials in another exclusive video interview with The Dermatologist!

Dr Cotliar: When we last spoke, we had talked about the fact that at Science 37, we've done a lot of internal prototyping and validation work to demonstrate that remote assessments of typical dermatologic endpoints done through digital photography. High‑resolution, large number of photograph sets is equivalent to basically the way that an investigator would assess a patient with a particular inflammatory skin disease in the clinic. I think the first version of that we did was demonstrating that the technology and the workflow makes that possible.

What we're doing now in working with some of our pharma partners is we're in the design phase of a couple of interventional dermatology trials for a moderate to severe inflammatory skin disease, things like atopic dermatitis and psoriasis, and demonstrating that one can assess both safety and efficacy of a new molecule in these interventional settings using digital photography as the basis to make those skin severity assessments basically.

That's really exciting and that's the evolutionary step of proving out the model. The hope is that aside from ensuring that there's patient safety which we always do during our trials, demonstrating that the design of the study and the scientific rigor put into that trial design will allow us to say, "Yes, this is a feasible model moving forward and that dermatology has a place in the execution of virtual trials."

There's so many considerations here. The way I would think about it would be, what is the ask if we're talking about conducting a trial like we do at Science 37 in a completely virtual way versus some hybrid where you're combining in‑clinic visits with telemedicine‑based visits that patients can participate in the home?

Sometimes in dermatology, we're very fortunate because we can use telemedicine and digital photography in a store‑and‑forward fashion so that there's no requirement that you would have to send a nurse or a mobile phlebotomist to a participant's home to complete some study‑based tasks or assessments. But that's not always the case, particularly for new medical interventions, whether those are oral or subcutaneous or intravenous where in addition to the administration of new molecules there's usually blood draws associated with it for the purposes of safety, ensuring patient safety. There's also blood draws to understand how the drug is being metabolized in individuals enrolled in a trial.

Of course, there are either patient‑reported outcomes which in many cases can be done on a mobile device in the home by a patient. If you're talking about clinician‑reported outcome measures that typically require the patient and the physician being in the same room, you have to make a determination about whether the endpoints in the given dermatology trial are able to executed using either store‑and‑forward or, even in some cases, live video to be able to collect that same level of data that you would in the clinic. There's all sorts of considerations.

What's really unique to telemedicine, I would say, in the conduct of research through telemedicine is medical licensure. Normally, when we think about a practice of medicine, if I'm practicing dermatology, let's say, in a tertiary referral center in the Midwest where my catchment area may be beyond the state where I physically work. If all of sudden you're telling the patients to stay home, and you're interfacing with them through telemedicine, you have to hold medical licensure in the surrounding states because in that setting, patients aren't driving. They're not in the same physical space. You need to make sure your licensure covers basically that entire catchment area.

That's something that's unique to telemedicine, whether that's standard of care delivered through telemedicine or research done through telemedicine.

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