Teledermatology continues to gain as a consultation option

Key Points

Some doctors predict this approach will become an important part of virtual healthcare in the future, offering increased access to the specialty, lower costs, and flexibility and added income for the practitioner.

"I think there is really no argument if you talk to the experts in healthcare reform that virtual health is going to have to be part of the equation," says Hon Pak, M.D., chief executive officer of the mobile technology company Diversinet of Irving, Texas.

Telederm landscape

That's down from 60 such programs identified in a 2003 survey by the American Telemedicine Association's Dermatology Special Interest Group. However, the volume of dermatology consults per site actually doubled over that period, says Dr. Armstrong, a member of the American Academy of Dermatology's Telemedicine Task Force and an author of a 2011 survey of telederm programs.

"Even though we have fewer programs, the programs that we do have seem to provide a lot of telemedicine services," she says.

The study, published in the January issue of Archives of Dermatology, gives high marks to teledermatology. Reviewing primary care records, Dr. Armstrong and colleagues found that 1,500 live interactive teledermatology consultations resulted in changes in diagnosis in 69.9 percent of patients and changes in disease management in 97.7 percent of patients.

"It is one of the few outcome studies in the field," Dr. Armstrong says.

Who is using it?

A broad spectrum of private practices, healthcare organizations and the government are already employing teledermatology, last year's survey shows.

Teledermatology sites offer a range of capabilities, including live interactive videoconferencing and the online store-and-forward approach, with which referring providers upload or send images of patients' skin problems in encrypted medical records.

Health maintenance organizations in particular are embracing the capability, according to Dr. Armstrong.

"For example, Kaiser Permanente in southern California last year provided over 6,000 (teledermatology) consultations, and this year they're projected to provide about 10,000 consultations," she says.

Teledermatology can help guide primary care providers where local dermatologists aren't readily available. The capability also can assist with triaging patients into conventional dermatology clinics and can provide remote support to clinics staffed by physician extenders with some dermatology training, according to Dennis H. Oh, M.D., Ph.D., associate professor of dermatology, University of California, San Francisco, and vice chairman of the American Telemedicine Association's Teledermatology Special Interest Group.