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Jonathan Cotliar, MD, on Virtual Trials and Telemedicine

Jonathan Cotliar, MD, Chief Medical Officer of Science 37, shares insights on the state of virtual trials and telemedicine in a post COVID-19 setting. He also offered some tips for dermatologists looking to take their practice digital during the COVID-19 pandemic in another exclusive video interview with The Dermatologist!

Dr Cotliar:  The big difference is telemedicine, in particular teledermatology, up to this point has been siloed from the practice of dermatology as a whole. What I mean by that is there are telemedicine‑specific organizations, whether it's general medicine, whether it's telepsychiatry or teledermatology, but it was pretty distinct from where brick‑and‑mortar practices existed.

What's happened now is a mechanism to provide continuity of care for people that heretofore were serviced in larger hospitals and health systems, there's been now an incorporation of telemedicine to allow for those patients and those doctors to maintain their relationships. It's not siloed. It's integrated.

What I think will be interesting will be to see moving forward, once COVID‑19...Not that it's not going to be a concern, but when it's less of a concern, and less of a risk for healthcare workers and patients to return to the clinic, how much clinical practice is done through geographically co‑located services, where you're in the same room, and how much it will remain at a distance through telemedicine.

I'm hopeful there'll be a large component that's still done through telemedicine because we've seen what the benefits are in terms of reducing the burden that patients have to take time off from work, to travel, to get care for their children, all the things that we all have to grapple with in our professional lives and no different than when we as doctors have to go to see doctors ourselves.

It's going to be fascinating to see where that level sets after COVID.

As dermatologists, even early in our careers, I would say, as trainees, the use of telemedicine, and sometimes informally so, patients, family members, everybody on the planet that we know sending us photographs of their skin and us having to render a diagnosis or [laughs] a judgment as to whether something warrants an in‑person screening, or even making an assessment as to whether an intervention has been effective, we're so used to that.

Then you have more formal telemedicine, again, whether that's in a standalone organization that provides teledermatology services or whether you're doing it in the context of research. We're so used to photography and video as the mechanism by which we as dermatologists can assess an individual's skin.

I don't know that what we're now currently doing with COVID‑19, or even moving forward anytime soon, is going to be that dramatically different than our experience early on in our dermatology training, and certainly in our formal dermatology career.

Teledermatology is a very natural next step in a specialty that lends itself well to the visualization of skin through photography or live video. Maybe one of the interesting challenges will be the distinction between patients who we've first seen in the same physical space, that we actually have developed a rapport with, versus patients who may be seeing us the first time through telemedicine.

As a physician, getting comfortable with that concept of meeting a patient for the first time and you're not geographically co‑located, or in the same physical space, probably has a little bit of a learning curve. Ultimately, as you do it more frequently, I don't know that it differs a whole lot from the experience one would have as a dermatologist in a brick‑and‑mortar, traditional setting.

There are probably some organizations in the pharma space or patients that don't mind the travel, whether, again, it's standard of care or clinical research done through telemedicine and telemedicine tools. They'll always be folks who are more comfortable with the construct at a site.

That said, telemedicine is just following a path that a lot of other industries have already laid the groundwork for in terms of how easy it is to perform certain transactions, whether that's reservations at a restaurant, airline tickets, even buying a home from the mobile device we have in our pocket.

What's going to happen is patients are going to understand that it's much less burdensome to have your care delivered to you from the comfort of your own home without the need to travel, without the need to take time off from work, without the time it takes to find a parking spot in a parking structure in a hospital, or pay a lot of money for a sandwich, or wait for a doctor in a waiting room for an hour or two when you're trying to get back home to pick up your kid from school.

The expectations will be, even in a world where the same concerns about COVID‑19 may not be as prevalent, that they want a more efficient and patient‑friendly experience. What that will mean is the expectation that telemedicine services will be offered for many of the appointments that we're all accustomed to driving to the clinic or the hospital for today.

That's probably the natural evolution of where this goes.

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