Feb 09 2022
Patient-Centered Care

Teledermatology: Tech Tips for a Better Virtual Visit

Telehealth visits make dermatology more accessible to patients, but additional technology implementations can support success.

Not all specialties are well suited for telehealth, but dermatology is one that works with the right technology in place.

According to a survey conducted by the American Academy of Dermatology’s Teledermatology Task Force, 14 percent of responding dermatologists reported that they used teledermatology prior to the pandemic; 97 percent reported they used it during the pandemic.

The survey was conducted in May and June 2020, early in the pandemic. At that time, more than half of responding dermatologists expected to continue teledermatology use after the pandemic.

However, Dr. George Han, director of teledermatology at Northwell Health, says the survey doesn’t capture all of the barriers to telehealth in the field: Some patients get frustrated with the technology, and in other situations, telehealth falls by the wayside as patients return to in-person visits.

Teledermatology can have many benefits for both patients and providers, but it’s important for healthcare organizations to set up their programs for success with best practices and strategic technology implementation.

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The Benefits of Teledermatology for Patients and Providers

Dr. Carrie Kovarik, professor of dermatology at the University of Pennsylvania’s Perelman School of Medicine, explains that teledermatology gives providers more tools to see patients and allows patients to receive care more quickly.

“It helps us be more available and gives them more options,” says Kovarik.

She says that if telehealth continues to be reimbursed by the Centers for Medicare & Medicaid Services once the emergency waivers now in place end, dermatologists will likely use telehealth to provide hybrid care delivery to meet patients where they are.

Han puts the reasons for telehealth use into three buckets that should guide how a telehealth program is designed: convenience, access and safety.

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Teledermatology becomes a convenience when people have access to dermatology specialists but don’t want to have to take off work to make an appointment. Instead, they can hop on a phone or device from wherever they are.

Some people don’t have access to dermatology specialists in their areas, and the closest hospital may have long wait times for appointments. In other cases, people may have difficulty traveling to appointments due to medical issues or logistical barriers. Telehealth makes dermatology accessible to all these groups.

Finally, teledermatology helped patients protect themselves from exposure to COVID-19 at the height of the pandemic.

“Removing barriers to access is what the technology is about,” says Han.

How Is Teledermatology Used in Patient Care?

Teledermatology is a useful tool to supplement in-person visits. It can be used for follow-up visits when patients have conditions, such as acne, that don’t require detailed exams, or for management of chronic conditions like eczema or atopic dermatitis. Photos and video may be good enough to aid in diagnosis or for medication counseling.

Kovarik says, however, that teledermatology should only be used to see new patients when necessary, since full-body exams cannot be conducted via video. However, it remains useful in cases where a patient has a focused problem.

“Dermatologists are getting good at knowing what we can and can’t do with the technology,” she says.

Patients show an increased willingness to check in more often, and Han says dermatologists get better compliance and results when using teledermatology.

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How Technology Improves Virtual Dermatology Visits

Han says patients often request teledermatology visits due to convenience or accessibility issues, but the approach isn’t ideal in all situations.

“If there’s a suspicious mole, we can do a biopsy right away when in person. With teledermatology, there’s an extra step because we have limited resources to solve the problem virtually,” he explains, adding that tests kits can be sent to patients’ homes in some cases.

It can be difficult for dermatologists to clearly see the sites they are examining during a telehealth visit if patients are not familiar with the equipment.

“Because dermatologists were never the ones asking for telehealth solutions before the pandemic, no tech company designed a specific solution for teledermatology. There’s not a platform that supports high-quality photos,” says Han. “It’s up to us to improve the technology so we can become more efficient.”

It’s important for dermatologists to ensure their technology infrastructure lines up with the logistics of an efficient visit, such as having quality image-capturing ability and making sure the telehealth platform integrates with an organization’s electronic health record system.

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To mitigate the issue of image quality during telehealth visits, Han suggests dermatologists have patients send photos prior to the appointment. It’s best for healthcare organizations to collect these photos via a HIPAA-compliant email server that guarantees encrypted and secured image storage. Images can also be collected using a patient portal or telemedicine portal. Kovarik says Penn also accepts images via text.

Technologies such as AI-assisted image capture can help patients to take quality images. He says that patients often send in photos of their skin conditions that are blurry or of low quality. AI can ensure the patient captures a sharp, well-lit image and that the photo configuration matches previously submitted photos for comparison.

“It’s all about making sure we have the efficiencies in place to get high-quality information. Not having good quality doesn’t serve anyone well,” says Han. “We don’t want to sacrifice quality of care for convenience.”

The next step in AI for dermatology is training the technology to identify skin conditions on all skin tones, especially darker skin. Current training sets are too narrow, according to Han, but he adds that the problem goes beyond AI. In many instances, cameras themselves are not calibrated in a way that’s well-suited to capture detail or inflammation on the skin of people of color.

Dr. George Han
As long as dermatologists are willing to take part in the conversation to design better platforms, workflows and systems, there is a great opportunity to give more people access to care.”

Dr. George Han Director of Teledermatology, Northwell Health

Setting expectations is also important to the success of a teledermatology visit. Healthcare organizations can do this by providing onboarding literature so patients can check technology access before the visit. Kovarik says it can often fall on the dermatologist’s shoulders to walk patients through technology setup, so sending instructions beforehand with an easily accessible link can mitigate that issue.

Han says Northwell Health is using a platform that pushes out a text message to invite a patient to join the video visit. Patients only need to allow the platform to access their cameras and microphones.

“The whole process takes under 15 seconds,” says Han.

Healthcare organizations should instruct patients to test their cameras and sound and make sure they’re in a private, well-lit location with good connectivity. This information can be distributed through text, email or the patient portal.

“People may be frustrated with teledermatology technology or the way it’s been implemented, but those are all solvable problems,” says Han. “As long as dermatologists are willing to take part in the conversation to design better platforms, workflows and systems, there is a great opportunity to give more people access to care.”

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