With many people having access to cameras and internet, teledermatology is gaining popularity with the potential of getting a dermatologist’s consultation in a shorter time (compared to a long referral wait). This 5-part series explore the numerous aspects of teledermatology, much of the information is from dermatology associations like the American Telemedicine Association, American Academy of Dermatology, British Association of Dermatologists (BAD) and numerous published research/review papers.
What is Teledermatology?
Teledermatology is a skin consultation carried out remotely using telecommunications, it can take different forms such as:
Store and Forward – This refers to images being stored, sent to the dermatologist with patient information who will then revert with the consultation. Thus, it is not ‘real time’.
Real-time Interactive – This uses videoconferencing.
Direct-to-patient – Images are sent to the dermatologist and there is a live interaction.
Triage consultation – This involves two physicians, where one physician (referring physician) will send the patient information and images to the dermatologist and interact with the dermatologist. The patient interacts with the referring physician.
Store and Forward – When is it Used?
Store and forward is increasingly used, in various forms of skin consultations.
In direct-to-patient teldermatology, store and forward is between:
- Patient and Dermatologist
- Patient sends his medical history and images directly to dermatologist
- Dermatologist provides care directly to patient
Store and forward can also be used in teletriage, whereby:
- Referring physician interacts with patients, to obtain medical history and skin images
- Referring provider sends the patient information to dermatologist
- Dermatologist decides on next step – in-person consultation, tele consultation or no specialist consultation required
- If it is to be via tele consultation, the dermatologist provides a consultative report back to the referring provider with a skin management plan
- Referring physician is responsible to carry out the treatment recommendations
Some ‘Get Started’ Pointers for Patients:
#1 Be clear about what you sign up for
As there are various forms teledermatology can take, make sure you find out which one your referring provider has in mind – will he remain as your primary care doctor or it is expected to eventually lead to a referral to see a dermatologist directly
#2 Licensure and board certification of dermatologists
In certain countries/states, there are regulations that mandate patients have a choice of dermatologist, access to where the dermatologist is licensed and what are his/her board certifications. Sometimes dermatologists can provide teledermatology only in states where he/she is licensed. Other states regulate that prescription can only be provided when there is a live interaction. Being licensed in a particular state may also mean being familiar with the health care infrastructure and the resources you (as the patient) have access to.
#3 Access to in-person followup
It would be ideal for you to have the option to access to the dermatologist in-person even if the teledermatology is currently not direct-to-patient form. Where the teledermatology is direct-to-patient, dermatologists are expected to have met you in person or to do so via a live video conferencing before prescribing medication.
#4 Expect your medical history to be stored and transmitted
As opposed to in-person consultation where images of your skin may not be taken, teledermatology relies on the storage of such images to be transmitted to a dermatologist. There are guidelines on collection of patient data and on privacy. Some data that are required to be collected are:
Medical history – for instance, history of eczema or atopic conditions in family
Medical records – past treatment given and current treatment will be documented electronically for all physicians in your care team to have access to. The patient’s existing primary care physician and dermatologist (if any) should be identified.
#5 Right doctor at right time and place
No matter what form of teledermatology, it should be no less effective and efficient than a in-person referred consultation. The main advantage of teledermatology is the potential to receive a specialist consultation sooner and to have access to the right doctor. The teledermatology process should not end up being convoluted and time-consuming.
Have you tried teledermatology? Has it benefited you? Share in the comments so that the rest of us can benefit!