UC Davis teledermatology program improves diagnosis, outcomes

Key Points

Davis, Calif. - A teledermatology program based at the University of California, Davis, frequently alters referring physicians' diagnoses and management plans, thereby improving patient outcomes, its director says.

The project's 33 remote sites span from Northern California to San Diego, approximately 500 miles south of Davis, Dr. Armstrong says. Presently, the program handles approximately 1,500 live interactive (LI) consults per year. These consultations involve one of the program's three dermatologists interacting in real time with a patient over a secure video link.

The LI link requires videoconferencing equipment at both ends, a secure T-1 telecommunications line and, on the referral end, a special skin camcorder.

"It's a medical-grade video device that can be plugged into the main unit. That allows the dermatologist to look at the skin more closely than using the regular camera on the videoconferencing equipment," Dr. Armstrong says.

Referrals must come from primary care physicians, "But the actual images and patient histories can be taken by other medical staff."

In an unpublished study that retrospectively analyzed 1,500 LI patient encounters, "We found that patients' clinical outcomes seem to improve once they come to teledermatology," Dr. Armstrong says. Factors that predicted improvement include changes in the referring physician's diagnosis (p = 0.013), which occurred in nearly 70 percent of cases, she says. Other factors include changes in patient management (p<0.0001), which occurred in 97.7 percent of cases, and the number of times a patient saw a teledermatologist (p<0.0001; Armstrong A. Unpublished).

"Without the right diagnosis, it might be difficult to recommend the correct treatment. In some cases, even if the diagnosis was initially reached by the primary care provider, the dermatologist was able to optimize the management so that the patient would have improved outcomes," she says.

The program also facilitates nearly 400 store-and-forward (S&F) consults yearly. S&F teledermatology relies on the transmission of high-quality digital clinical photos to UC Davis dermatologists, who examine them as their schedules permit.

AAD task force

Additionally, Dr. Armstrong participates in the American Academy of Dermatology ad hoc volunteer teledermatology task force.

"Along with Miki Garcia, M.D. (assistant professor of dermatology, UC Davis), we provide volunteer teledermatology services to some of our clinics," including a free student-staffed clinic that runs every weekend in Sacramento, she says. "Anyone, regardless of insurance status, is able to access teledermatology service at these clinics."

Because it's an all-comers clinic, Dr. Armstrong says teledermatology services may be needed on days where there are no on-site volunteer dermatologists. However, she says, "I could be away at a conference, and if they call me, I can evaluate a photograph and get recommendations back to them."

Regarding payment for the main UC Davis program, she says, "LI teledermatology is reimbursed by all insurance carriers in California. S&F teledermatology is also reimbursed by insurance carriers, with the exception of Medicare." The teledermatology program usually handles reimbursement for Medicare patients through contracts with referring sites.