Teledermatology initiative allows wider access to care

National report - Although use of teledermatology is growing, such programs face obstacles, including a lack of federal reimbursement, experts say.

Still, they agree that the ability to see faraway patients' problems can be a valuable adjunct to standard clinical care.

If nothing further changes in healthcare reform, says Hon S. Pak, M.D., chairman of the American Academy of Dermatology (AAD) teledermatology task force, "The workforce shortage (in dermatology) will worsen." Reasonable solutions include hiring more primary care providers, and subsequently specialists, while leveraging existing physicians to serve more patients, he says.

As of Nov. 23, 2010, these sites were handling nearly 100 cases total weekly (versus 47 in September), Dr. Pak says.

At one volunteer site, the University of Missouri's Missouri TeleHealth Network (MTN) uses both digital photos and live interactive videoconferencing, says Karen E. Edison, M.D., MTN medical director.

"We've been doing teledermatology to rural, underserved areas for more than 15 years," she says. These efforts allow the MTN to see approximately 25 dermatology patients weekly - and to earn patient satisfaction scores of about 97 percent, she adds.

Such successes aside, Dr. Pak says the AAD is working with the American Telemedicine Association and the Centers for Medicare & Medicaid Services (CMS) to expand telehealth reimbursement to include not just live interactive videoconferencing, which CMS covers in certain rural areas, but also store-and-forward telemedicine.

Although states such as California and Hawaii already reimburse for the latter, "It's not consistent throughout the United States," he says. "Healthcare reform will have to change that financial incentive for things to take off."