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Telemedicine and Telehealth Applications: Teledermatology
The majority of dermatologists practice in or around urban areas, which leaves rural areas with fewer specialists. Teledermatology can be a means of delivering specialist care to these out of reach patients. This is very important because of the fact that many general practitioners are unable to diagnose even the most common dermatological diseases. During a teledermatological consultation, a dermatologist will evaluate clinical and laboratory data, make a diagnosis, and prescribe therapy for patients located at a distance. Ultimately, the goal is to provide care to dermatology patients in underserved areas, improve the quality of care, and decrease the cost of care. (Darkins and Cary, 2000) Although promising, teledermatology does also have its problems. The first and major disadvantage is the inability of the consulting physician to physically examine the patient’s skin (physical examinations are a major way the dermatologists evaluate and treat patients). For example, in one case, the consulting physician is unable to palpate the skin, and as a result, the doctor is unable to make a fully informed decision. Secondly, the lack of proper reimbursement schemes in some countries inhibits the growth of teledermatology. Unfortunately, only a few states reimburse for teledermatological services and often times, it is only partial reimbursement. Live-Interactive Video (Real-Time) vs. Store-And-Forward TeledermatologyTeledermatology programs can be deployed using either live-interactive video (real-time) or store-and-forward technology. The store and forward technology is more convenient due to the fact that there is no need of a consulting physician at the same time as the referring physician and patient. Additionally, compared to the other type, the store and forward method is also time efficient. However, this method does have its disadvantages. The consulting physician can not ask the patient any questions and he can not ask for certain images or close- up images. This can be very problematic because it prevents the consulting physician from making a better diagnosis. The first technique, called the live interactive technology, is done live via telemedicine equipment. The major advantage to using this type of technology is that the consulting physician can ask the patient and referring physician any questions that may be essential to making a diagnosis and carrying out treatment. Both technologies use two very useful instruments, a dermatoscope and microscope. Two Examples of Teledermatology SystemsKvedar et al (1999) describe the design, development, and technical evaluation of a teledermatology system utilising digital images and electronic forms captured through, stored on, and viewed through a common web server in an urban capitated delivery system. The authors designed a system whereby a primary care physician was able to seek a dermatological consultation electronically, provide the specialist with digital images acquired according to a standardised protocol, and review the specialist response within two business days of the request. The settings were two primary care practices in eastern Massachusetts (US) that were affiliated with a large integrated delivery system. Technical evaluation of the effectiveness of the system involved 18 patients. Main outcome measures included physician and patient satisfaction and comfort and efficiency of care delivery. In 15 cases, the consultant dermatologist was comfortable in providing definitive diagnosis and treatment recommendations. In 3 cases, additional information (laboratory studies or more history) was requested. There were no instances where the dermatologist felt that a face-to-face visit was necessary. In the UK, video conferencing has already helped to deliver teledermatology and health education services to GPs in rural practices in Powys, mid-Wales. The system, which directly linked a consultant dermatologist to 13 GP practices, allowed the consultant to view a patient’s condition. The system used a specially customised video camera, with special facilities to allow for accurate image transmission to the consultant. For a more detailed view, still images were captured, compressed and sent as data files. The GPs also used the system to deliver lectures and hold workshops as part of Continued Medical Education (CME) to the geographically dispersed health care professionals within the group using multipoint videoconferencing. Benefits of such a system are various and include:
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Dermatology involves various activities such as talking with the patient to
elicit a history, visual pattern recognition, surgical treatment and pre- and
postoperative management. Teledermatology, the use of telemedicine for
dermatological consultations, can serve as a good model for other telemedicine
specialities. In particular, a key element in making a dermatological diagnosis,
visual inspection of the skin (dermatology is a very visual medical speciality),
can be readily transmitted via telemedicine techniques. (Web site of La Trobe University
e-Health, Australia, 2000)
