The American Academy of Dermatology (AAD) defines teledermatology as the remote delivery of dermatological services and clinical information with the help of telecommunication technology. There are two types of modalities in this health care model – ‘Store-and-forward’ in which digital images and associated patient data are sent and forward to the specialist for storage and consultation, and ‘Live-interactive’ in which providers and patients interact through live video using a variety of peripheral hardware attachments to enhance the consultation. So the telemedicine model allows patients to send details and interact directly with the dermatologist and enables physicians to send patient information to a dermatologist and interact directly with the specialist for consultation or triage. Let’s take a closer look at how this health care model is improving health outcomes and rich.
Major Benefits of Teledermatology
As per the American Association of Telemedicine, teledermatology is one of the most active telemedicine applications in the United States and is helping dermatologists to extend their reach to patients in a cost-effective manner. A recent study published in JAMA Journal reveals that this health care model is proving a reliable mechanism for the triage of inpatient dermatology consultations and can enhance efficiency by enhancing access to specialized care for hospitalized patients. Healthcare experts perceive three main benefits for this model over traditional visits:
Better Communication – In the traditional office visit, a patient normally has a 5 to 15 minute consultation with the dermatologist and most of the instructions for the treatment and helpful skincare advice given is immediately forgotten. This gap is often filled by the pharmacist or by the patient browsing the Internet or calling up the physician. E-consultation enables the specialist to provide a detailed analysis of the diagnosis, treatment instructions, and a specific plan to follow (on-demand resources) which can be accessed by patients from their smartphone or computer at any time. This model allows patients to message their dermatologist about their condition along with necessary images instead of self-diagnosing side-effects or reactions to the treatment. Patients thus experience a sense of continuity in their consult with the specialist.
Efficient Measurement – In online consultation, patients can upload photos of their skin during the first consultation and also for each follow-up. This consistent and visual documentation of the patient’s condition makes online diagnosis more efficient than that in a traditional office setting. Evaluating the patient’s before and after photos would allow the dermatologist to see how their condition has improved so that immediate feedback can be provided on the progress of the treatment. If the dermatologist sees many patients each day, they may not specifically remember what the patient originally looked like in case of a follow-up visit. They usually rely on their charts and notes, which obviously do not measure up to the crucial information provided by the quality close-up images of the affected area that the patient sends.
Easy Access – A 2001 study showed that around 42% of Americans live in areas underserved by a dermatologist. The AAD also sees a shortage of dermatologists in general and has published a map that highlights underserved areas. Teledermatology is the best alternative to render dermatological services and information to these areas. This system allows anyone with smartphone or computer to access care through online consultations and enables low-risk conditions to be treated online. Another major benefit is that it supports both asynchronus (not simultaneous, for example, e-mail) and synchronus (simultaneous, for example, Skype call) care. In synchronus care, a call has to be scheduled in advance so that the physician is free and ready to participate in the conversation. At the same, the physician can respond at a time that best fits their schedule in case of asynchronus care. Dermatologists can treat their patients as best fits their work flow with this type of care and fill excess capacity with a pending online consultation for diagnosis and treatment
Crucial Role of EMR
Clinical documentation can be quite challenging in the context of providing health care services to patients in remote areas. Electronic Medical Records (EMRs) play a crucial role in managing this issue. The standard point-and-click technology with EMR makes it easy for the dermatologist to enter patient details collected at the time of online consultation into the computer. They can browse through the available choice of clinical terms and click on the appropriate one to generate the medical record in electronic format. Once the electronic record is created, they can easily retrieve the requisite data from their computer at either time during the online consultation. This quick and easy access improves the quality of the patient care and reduces operational costs as well. If the EMR is integrated with teledermatology through wireless technology, it will become quite easy to treat and diagnose patients living in remote areas. A good EMR offers the following benefits:
- Captures complete patient health details and customizes the data
- Provides clinical decision support
- Enables complete patient charting
- Manages patient scan/images
- Allows patients to access their medical information online
- Allows doctors to share medical information with specialists at distant places
EMR allows data entry in various ways – via keyboards/mouse/touch screens (for primary patient data including diagnosis, patient history and findings), camera (for video signal transfer), speech-to-recognition systems, and transcription. Integrating EMR with transcription by professional transcriptionists can produce documentation that is much more accurate than point-and-click and speech recognition technologies. Transcribed teledermatology reports integrated with EMR can greatly enhance the online consultation process.
Tips to Optimize Telecare
Remote dermatological consultations should be performed on a HIPAA compliant web-based platform. The success of this health care model depends on the ability of the healthcare provider to establish authentic relationships with patients, the proper definition of quality care in the telemedicine environment, and the availability of the requisite technology to make it work. Healthcare experts have put forward the following conditions to optimize the quality of online care:
- Make out a medical problem with a diagnostic data set so that it can be acquired by the patient/consumer in easy and reliable manner
- Ensure that the patient understands that the online consultation is problem-specific and may carry risks such as omitting care that involves other health issues
- Assure the patient that the treatment decisions for a specific condition are algorithmic and do not need an authentic relationship
