Presented by: Jules Lipoff (University of Pennsylvania), Elizabeth Jones (Thomas Jefferson University Hospital), Dr. Tirilokraj Tejasvi (Michigan Medicine, University of Michigan, Michigan), Dr. George Han (Mount Sinai Beth Israel)
Virtual consultations and triaging have been pushed by the COVID-19 pandemic. This has led to a better understanding of the use of telemedicine. Ever since, telemedicine in dermatology -teledermatology- has increased drastically from 14.1% to 96.95%.
When COVID-19 hit, telemedicine increased access to care and allowed to continue with consultations [1]. In this way, it was still possible to deliver care while social distancing. Before the pandemic, telemedicine was not widely used. Reasons for this were reimbursement, concerns about liability, and restrictions by medical licensing. It is still unclear what long-term policy changes will be, but it definitely opens a door.
Teledermatology is best suited for follow-up and acne consults. Total body skin exams continue to require a personal appointment, but acne consults have turned out to be suitable in a digital form as the lesions can be easily shown by camera and in pictures.
Barriers still need to be overcome, including technology and digital divide. A major drawback is the limited digital access of minorities, reducing their access to care. Another limitation lies in the health insurance landscape, as policies are differently impacted. Low reimbursement has been identified as a hurdle too. A final limitation is the shift from direct-to-patient (DTP) to direct-to-customer (DTC) healthcare. On the one hand, DTC is increasingly popular, but risks at overdiagnosis and overtreatment as each consult will result in a prescription. On the other hand, DTP goes beyond prescribing medication and can be useful for education and long-term care.
The pandemic has turned the spotlight on teledermatology. Despite limitations, it will likely find a permanent home in practice. Until practices open completely and with the ongoing requirements of social distancing, a hybrid version can be considered. Even post-COVID-19, a hybrid approach in outpatient care could be worthwhile.
- Lipoff J, Jones E, Tejasvi T, Han G. Lessons on Teledermatology From COVID-19 and Planning the Future, Session U003. AAD VMX 2021, 23-25 April.
