Practicing Teledermatology Moving Forward

Link to original article

“To be converted one must first be convinced.”

Lailah Gifty Akita

Introduction

• Teledermatology (TD) or Telemedecine for Skin Diseases is the use of Information & Communication Technology (ICT) applied to the diagnosis, treatment and management of dermatological conditions.
• Using ICT, dermatology can benefit greatly in a both effective and safe way.
• Convinced dermatologists and convinced patients have the biggest impact.
• In this article, I would like to share some of the actionable things I learnt adding this tool to my daily practice.

Pros and Cons

• TD is a useful tool to sort out common problems which results in:

1. convenient management solutions. TD reduces geographical barriers such as distance.
2. effective triaging of conditions which need to be handled at the office urgently or not.

TD also also has disadvantages:

• It is easier to do real-time video consultations, thanks to increasing technological power.
• Thus online consultations can no longer be reduced to “store-and-forward” only.

However store-and-forward remains a must moving forward for the following reasons:

-Picture Quality and Clinical History: without proper information there is little time to reflect:

• Videos still are not enough to obtain quality images and it is easy to miss questions.
• In that latter instance, it takes time to elaborate a questionnaire, but an effective usage subsequently allows to gather more information.

-Time Constraints:

• With a live consultation, it is easy to spend time not dealing with the specific issues required for follow-up:
• lack of visibility and documentation.
• Thus consultation times increase to try to compensate for the lack of quality.

• Also time needs to be allocatted to live video consultations (specific time slots).
• Either online and “in-person” consultations are mixed together or separate.
• It’s difficult to keep to time…wasting a lot of it and subsequently generating stress for practitioners.

• Also in my experience it is not easy for patients to wait to long for online appointments. A few days tend to be acceptable: a few days, maybe a few weeks, but definitely not a few months as it can be the case for “in-person” appointments.

You can provide an objectively accurate expert opinion using this method:

• Give a management recommendation.
• Request for more information to complete the request.

A service to our patients

• Since the pandemic, you can all see that digitization is here to stay because it's convenient. For example consulting patients can often be done remotely (not always).
• It’s advisable for the dermatologist to check in advance with the patient if communicating remotely is an option.
• When it comes to me in practice: I do not provide consultations for new patients, but to existing ones only.

How I do it.

• Before seeing the patient, I ask the patient to send his complaint using store-and-forward Teledermatology.
• I use an App (LINK) and give my code to the patient. (No other information is shared so I ask the patient to send me an email at the same time he or she submits a request).
• After reviewing and replying to the case, I schedule a video call with the patient to go over the findings, conclusions and management plan.
• It is also the time for non-factual communication, something which has a tendency to be missing in general.

I hope you’ll find this article useful ! Comments welcome.

References

1 Article on Teledermatology use published in EADV Newsletter (Summer 2020)

2 App (Android and iOS)