A growing trend in health care, accelerated by the COVID-19 pandemic, is the implementation of telemedicine. Telemedicine is the delivery of health-related information and services among patients and providers via telecommunication technologies. An example is the use of video technology by doctors to evaluate, diagnose, or treat a patient instead of having a face-to-face encounter. This has been especially useful during the pandemic in order to lower the risk of COVID-19 transmission. One medical field in which telemedicine is particularly successful is dermatology.
Patient using live-interactive teledermatology to speak with a doctor.
Dermatology is a highly visual medical specialty, which makes the management of skin diseases more suitable for telemedicine. For example, patients can send pictures of skin lesions with their phones, tablets, or laptops to their doctor. Also, in many regions, there are long wait times to see a dermatologist and a limited number of dermatology practices. Teledermatology can be an efficient option to get patients seen faster than they normally would. Studies show that teledermatology can produce accurate diagnoses, high patient satisfaction, and equivalent health outcomes compared to conventional care.
The two main models of teledermatology are store-and-forward (SAF) and live interactive (LI). The SAF model is asynchronous: patients provide clinical history and pictures to a dermatologist who then follows up later. The LI model is a synchronous face-to-face method where a patient and dermatologist have a real-time appointment over video. The SAF model has been more popular due to increased accessibility and fewer technology restrictions. In addition, referring physicians can use teledermatology to consult a dermatologist about their patient’s condition. There have been several analyses of teledermatology programs that highlight specific strengths and weaknesses.
Strengths
A significant benefit of teledermatology is increased access to dermatologic care. Geography, insurance status, and other sociodemographic factors may limit patients’ access to dermatology. Teledermatology mitigates this issue by enabling more patients to communicate with dermatologists. For example, a farmworker who does not live near any dermatology practices and cannot leave work during the day for an appointment can use teledermatology to send a picture of their skin lesion to a dermatologist to review.
Teledermatology is effective at reducing wait times and improving appointment scheduling. Dermatologists can use teledermatology for triaging in order to determine whether a patient may require an in-person visit. While some patients require a biopsy or advanced care, others can have their concerns quickly addressed without the hassle of scheduling an in-person visit. This reduces the burden on patients and assists physicians with their workload. Through streamlining the referral process and facilitating appointment scheduling, teledermatology can increase patient satisfaction and improve healthcare delivery.
Despite variation in reimbursement policies for teledermatology across states and payers, research has found it to be cost-effective. A recent study found that implementation of a teledermatology triage system was associated with significant cost savings in a managed care setting. Another study showed that when evaluating operating costs and reimbursements, teledermatology is an economically viable approach for providing dermatologic care in remote regions. Cost savings come from fewer referrals, less patient travel time, and fewer in-person visits. However, other studies have found insignificant cost reductions when comparing SAF teledermatology to conventional referral systems. This may be due to the type of economic perspective used for analysis and inefficiencies within a specific clinical setting. Ultimately, in an era where health care costs continue to rise, teledermatology may serve as an effective solution.
Weaknesses
Medicolegal considerations about the implementation of teledermatology have partially hindered its widespread adoption. Breaches of confidentiality can occur if systems are not equipped to securely transmit and protect medical data. Teledermatology platforms must encrypt health communications, and providers must inform patients how their information will be used, stored, and shared. Currently, there is no standardized system for teledermatology that preserves patient confidentiality, which can delay patient and provider buy-in.
Teledermatology is ineffective if there are issues with technology on either the patient or the provide side. Patients require special guidance about how to take pictures and angle their cameras to capture skin lesions. An image with poor lighting, lack of focus, or obstructing artifacts like hair can impair a dermatologist from making an accurate diagnosis. Some lesions require diagnostic evaluation with dermoscopy or biopsy, so patients must still make an in-person appointment. Also, limited bandwidth and internet connectivity are barriers that prevent some patients from using LI teledermatology. If these patients are from low socioeconomic communities, teledermatology could exacerbate skin health inequities: patients who already have disproportionate difficulties in accessing dermatologic care will not be able to utilize teledermatology.
Future Directions
Overall, teledermatology has high prospects for improving the management of skin diseases. Access to dermatology is restricted in many regions for multiple reasons, and teledermatology can mitigate this issue. It can connect a larger volume of patients with dermatologists in a timelier manner. This may be especially relevant for rural and low-income communities, helping alleviate skin health inequities. Widespread implementation of teledermatology requires the creation of accessible, secure teledermatology platforms and a reliable reimbursement system. Future directions for teledermatology include the integration of artificial intelligence and machine learning, though the clinical readiness of these technologies needs to be further assessed. Teledermatology may also be used to improve quality of care as well as medical education on dermatologic conditions. Advancements in telemedicine workflows and technologies will facilitate the growth of teledermatology, which can improve the delivery of dermatologic care.
Editor’s note: This post was one of the winners of our 2021 Student Blog Competition. Congrats, Raj!
Raj Fadadu