Specialists can be extremely difficult to access almost anywhere in the world, and this is especially a problem in remote regions. Dermatologists are in high demand everywhere, and it’s not uncommon for patients to have a difficult time finding a dermatologist in a timely manner.
Teledermatology is a relatively new subspecialty in medicine that has enormous potential to increase service to patients, and expand the scope of health care, while potentially saving costs for the health care system as a whole as well as the patient. There are generally two types of teledermatology: Live-Interactive, and Store and Forward. Live-interactive is a consultation via teleconferencing, while store and forward is mainly for diagnosis via digital images. These can be performed directly with the patient, or more commonly (at present), through the intermediary of a primary health care provider.
There are some distinct and important advantages of this type of care. It has very low overhead, and all that’s required of the physician is to have software that complies with the rules and regulations of their medical association, and for the patient, they can get a screening or a diagnosis from home. The more popular “store and forward” method where patients send photos, and then dermatologists get back to them later, also has the potential to expand the number of dermatologists that can practice on a more flexible schedule. Many dermatologists frequently travel to conferences regularly to stay ahead of the latest advances in medicine and therapeutic techniques, and these people can participate on a more flexible schedule. Semi-retired physicians can also contribute without the full commitment of keeping regular office hours. This technology will likely be of most immediate help to general practitioners who need timely advice from a specialist. Most importantly though, it has the potential to expand timely health care services to regions that are underserved, typically remote regions. In the future, this mix of technology and dermatology may expand further beyond consultations, and near-live learning environments for medical students could benefit future physicians and their learning rate.
Advantages and Disadvantages (Now and in the future)
Upsides:
- Expanding accessibility to specialist services for patients, especially for patients in remote areas or where access to quality care is traditionally restricted.
- Speeding up wait times for seeing specialists.
- Compatibility: Dermatologists are trained to look at images from the first time they open their medical textbooks, making teledermatology a familiar format. Visual cues also provide much more information compared to other areas of medicine.
- Adding flexibility to a dermatologist’s schedules (in-store and forward dermatology), thus increasing their productivity and hours.
- Other potential uses like medical education (with patient consent of course).
Downsides:
- Quality of diagnosis and overall care partially dependent on the quality of images and even camera equipment.
- Internet connection may be a problem for some areas.
- Lack of direct interaction with patients can reduce the more subtle information that may be available to the dermatologist in a live person-to-person setting.
- The infrastructure, equipment, as well as bureaucratic barriers like a system for dermatologists to get reimbursed while being rapidly built on, are still lacking at this stage.
- Patients and dermatologists can both feel hesitant about the new technology until they become accustomed to it.
- Dermatologists may be concerned about liability issues more than their usual consultations.
While numerous challenges need to be tackled, both regulatory and practical, the potential is enormous. Teleconferencing is expected to become more commonplace in the future, expanding on the potentials for direct consultation from home. Similarly, removing the barriers of distance will allow general practitioners access to specialized knowledge not just in dermatology, but also in other specialties. Teledermatology is still in its infant stage, but it’s already extensively discussed by medical bodies like the American Academy of Dermatology, and the Canadian Dermatology Association.
