The tech connection

By Ruth Carol, Contributing Writer, March 1, 2022

The patient-physician relationship isn’t the only one impacted by social distancing due to COVID-19. The pandemic has taken a toll on peer-to-peer communication, as well. Asking a colleague about a suspicious lesion isn’t as easy as it once was and texting a picture on a mobile device is not always secure. Fortunately, tech tools have stepped up to enhance colleague communication and even improve collaboration in some ways that will likely stick around once the pandemic has turned endemic.

“With COVID-19, we were all looking to strengthen those important connections,” said Ivy Lee-Keltner, MD, FAAD, deputy chair of the Academy’s Augmented Intelligence Committee. “These amazing tools have allowed us to connect, whether you see it as forced adoption or a revolution.”

Maintaining those connections is key, even with social distancing constraints, because collaboration and communication are essential in health care. Lack of teamwork and communication failures can increase the risk of medical error and decrease quality of care. Appropriate communication among medical professionals is not only linked to improved patient outcomes but also reduced costs. Inpatient dermatology consultation has been shown to improve patient outcomes and play an essential role in educating members of the health care team.

Just as telemedicine enabled dermatologists to conduct patient appointments when their offices were shut down, clinical collaboration platforms are helping physicians communicate with each other as the pandemic lingers. Simply put, these platforms are secure apps or programs that funnel health care communication and collaboration across an organization or community in one digital space. If you’ve ever used DermGrandRounds for teaching, jumped on a Zoom call to meet with partners, and/or attended the AAD’s Virtual Meeting Experience (VMX), you’ve used a clinical collaboration platform. 

Practice management, secure messaging

Practice management apps can help make a dermatology practice more efficient by streamlining scheduling, billing, and communicating with patients, but they also can be used to connect with colleagues, noted Swapna Pachauri, MPH, the Academy’s manager of Health Technology and Informatics. Similarly, secure messaging apps can be used to communicate among physicians, office staff, and patients. 

Many of these apps have similar features, but some have more bells and whistles than others. Features to look for include:

• Secure (HIPAA-compliant) text messaging 

• Ability to send/receive clinical content (images, videos, audio, charts, labs)

• Support for attachments

• Accessible on a smartphone, tablet, and computer

• Integration with the electronic health record (EHR) systems

The Academy recommends that dermatologists communicate with HIPAA-compliant sources, Pachauri said. Because an app vendor is generally considered a business associate, dermatologists should sign a business associate agreement with them. The AAD also recommends following federal and state regulations on information security, she added.

Physicians also use Microsoft 365 and Google Workspace (formally G-suite) in their offices, stated Katie Nunn, MBA, CMPE, a practice management consultant. Both platforms offer a suite of business apps including chat functions, document sharing and storage, online video calling and screen sharing, online meetings, audio conferencing, and phone capabilities. 

Steve Schuckit, MD, FAAD, a dermatologist in Brookfield, Wisconsin, uses Microsoft 365 at his practice. “Everyone at the practice has their own account with different tiers; one has encrypted email,” he said. When it comes to communicating with referring physicians at the hospital where Dr. Schuckit has privileges, their cloud-based EHR reigns. “The referring doctors are on it all the time, so it’s easy to reach them,” he said. “But it’s extra work for me because I am rarely on it.” Secure messaging can be done through the Wisconsin Statewide Health Information Network known as WISHIN. “But if I sent a message, it would go there to die because nobody checks it,” he said. 

Khang Nguyen, MD, FAAD, chair of the Academy’s Health Information Technology Committee, uses an app to send secure messages and images to colleagues at other institutions. Within UT Southwestern Medical Center, where he is an assistant professor, the EHR has built-in secure messaging. “It makes it so much easier to reach out to members of the care team, whether they are in or out of my department,” he said. “Having it integrated with the EHR makes all the information a click away.” 

These newer tech tools highlight the weaknesses of older forms of communication, Dr. Nguyen said. Images can’t always be sent securely over the phone, and verbally describing a skin condition isn’t always sufficient. Plus, there is no way to maintain a record of the conversation unless jotting down notes that must then be scanned into the EHR. Email is clumsy, not as dynamic, and can take several days to reach the physician. Faxes produce low-quality images. “The modern communication platforms improve upon all of these,” he said. “But physicians are very slow to change. Some people are not technologically savvy. They know how the fax works, so they continue to rely on it.”

The cost for these practice management and secure messaging apps varies as much as their features. For example, Microsoft Teams is included in a Microsoft 365 subscription. But encrypted email has an additional monthly cost, per user, Dr. Schuckit said. According to Dhaval Bhanusali, MD, FAAD, a dermatologist practicing in New York City, the cost varies, but costs increase with EHR add-ons. While some may balk at the cost, if the apps save time and stress, he maintains they are worth every penny. Before signing up, review a few options, match the features to the practice’s needs, and compare and evaluate, Pachauri recommended. An application may have a larger upfront cost, but it could be cheaper over time. Be sure to check on hidden and additional expenses, such as licenses and/or training fees, she warned. It may be beneficial to consult with a business manager or financial advisor.

Team conferencing

When COVID-19 halted in-person meetings, Zoom and BlueJeans took on a whole new meaning. Video conferencing platforms allow physicians to connect from anywhere without having to travel, stay in a hotel, and take time off from work and away from their family. “Team conferencing is not a perfect replacement for in-person meetings, but they are incredibly helpful tools for communication,” Dr. Nguyen said. “They’re great for meeting in groups or even one-on-one.”

Features to look for in video conferencing platforms include:

• Access to meetings regardless of device, browser, meeting platform, or room system

• Secure connections and high-quality video even in low-bandwidth environments 

• Integration with existing technology and workflow

• Interactive capabilities (share screens and files, chat)

Dr. Lee-Keltner both presented at and attended AAD VMX. She recorded her presentation one evening at home and then participated in a “live” panel discussion. “I missed the energy from the audience because it’s easier to engage with people when you are in the same room,” she said. “But, as an attendee, I loved the flexibility of being able to watch the lectures at my convenience when I am in the right mindset. For me, that’s early in the morning. For others, it may be in the evening.” Additionally, attending the conference virtually doesn’t limit her ability to attend lectures at overlapping times. 

“Team conferencing is not a perfect replacement for in-person meetings, but they are incredibly helpful tools for communication... They’re great for meeting in groups or even one-on-one.”

Since the pandemic began, Dr. Lee-Keltner has spoken at and attended more educational meetings than she had in the past because of the virtual option, citing an abundance of continuing medical education credits as proof. “I feel like it’s my second chance at medical school,” Dr. Lee-Keltner said. She even signed up for a virtual engineering course at the California Institute of Technology to learn about the data science behind artificial intelligence. Similarly, Dr. Schuckit has attended more dermatology-focused meetings than he had in the past because of the convenience of the virtual format. “I also attended conferences that I probably would never have attended simply because I just had to turn on my laptop,” Dr. Bhanusali said. 

Virtual conferences have evolved since the early days of the pandemic. “We’re learning to make these technologies more of a two-way street and using them more wisely even within this short timeframe,” Dr. Nguyen said. At a recent Texas-based dermatology society conference he attended, participants could “raise their hands” to ask questions and send messages to the speaker through a chat box as well as share screens and files. In April 2020, Nunn presented at a virtual conference, which basically meant, “I talked to my web camera for an hour and hung up,” she said. Fast forward to a November 2021 virtual conference, Nunn could poll the audience, see comments as they streamed in, and had a moderator field questions, all of which contributed to a more positive, interactive experience. Dr. Bhanusali is looking forward to virtual reality “when you can put on glasses and it feels like you’re there,” he said. That, he speculates, is five or six years away. 

For meetings and more

Team conferencing isn’t just for annual association meetings. Dr. Bhanusali was a panelist at a Skin of Color Society virtual town hall meeting hosted in the summer 2020 amidst the civil unrest that occurred across the country. “The conference calmed people’s nerves and brought them together for healing,” he said. And it never would have happened without this technology. “It was a moment in time that none of us will forget,” Dr. Bhanusali added. 

While Drs. Nguyen and Lee-Keltner use team conferencing platforms tied to their respective institutions for resident training. Dr. Bhanusali uses GoToMeeting and WebEx, but mostly Zoom because he likes its simplicity. “The silver lining is that I was able to connect with academic programs, residents, and students who I otherwise would not have been able to, given travel and time constraints,” he said. 

Digital technology has expanded the ability of physicians to learn, as well, Dr. Bhanusali said. He describes being able to read a paper, send a message to the author, and receive a response in real time as “the epitome of learning.” This technology has also made dermatology a more welcoming field, Dr. Bhanusali noted, by connecting dermatologists in rural areas, who may be the only one in their respective towns, with others across the country and world. “This technology should be used to support, nourish, and bring people together,” he added.

Dr. Lee-Keltner uses Zoom to attend an in-person turned online monthly book club in the Los Angeles area. Since pivoting to a virtual format, attendance has grown significantly. People can participate from home, no longer needing to arrange for childcare for those who have children, and they can dial in without the video if they want to multi-task, she said, adding, “We’ve had people Zoom in while folding laundry.” Recording the meetings enables even more participants to “attend” at a more convenient time. The group is trying to convene a hybrid version to accommodate individuals who want to return to in-person meetings and those who prefer continuing to attend virtually. It’s challenging to afford both types of attendees the same level of participation, Dr. Lee-Keltner said.  

Yaohui (Gloria) Xu, MD, PhD, FAAD, uses WebEx to host virtual meetings of the Melanoma Tumor Board at the University of Wisconsin School of Medicine and Public Health. Zoom, however, is another popular platform for departmental and institutional meetings. 

Dr. Schuckit uses Zoom and Microsoft Teams to meet every three weeks with his partners. The dermatology group practice has 10 dermatologists and three physician assistants in four locations. Sharing documents on the computer screen is much easier than searching through a stack of papers, he said. The virtual option also helps create a better work-life balance because he no longer has late-night commutes from the office and has more time to spend with his family. “As much as I like it, not all the partners do,” Dr. Schuckit said, adding that it can be difficult picking up on all the social cues during virtual meetings. The partners also meet with business associates on Zoom. 

Moving forward

As helpful as clinical collaboration platforms are, there is a glitch deterring their widespread adoption. The apps and platforms face the same interoperability issues as EHRs. “It’s like we all have cell phones, but you can only talk to someone who has the same carrier,” Nunn said. Using a messaging app to communicate with providers outside of her institution requires all of them to use same one, which would result in additional expense and effort at a time when everyone is trying to streamline communication tools, Dr. Lee-Keltner explained. 

“Digital technology is here to stay. We need to embrace it and use it to our advantage rather than be intimidated by it.”

In the meantime, dermatologists should familiarize themselves with the different platforms, Nunn suggested. Either start using one in their practice or explore the different capabilities of their existing platform. They have so many different features to improve efficiency and communication, she said, but the users aren’t always aware of their scope. The more physicians adopt these apps, the better position they will be in once interoperability is reached, Nunn said. Dr. Nguyen recommended talking to colleagues to learn which platforms they use. The AAD website provides a wealth of information about useful apps for dermatologists. Even when in-person meetings make a comeback, these tech tools will continue to play a role, he added. Dr. Bhanusali agreed. “Digital technology is here to stay. We need to embrace it and use it to our advantage rather than be intimidated by it,” he said.

“In 2022, physicians should be aware of all the tools available to them, whether they’re medical or digital, because these tools empower them to be the best version of themselves,” Dr. Bhanusali said. Dr. Lee-Keltner encouraged dermatologists to partner with developers to create apps and platforms that are designed to optimize workflow. “We know what works best and we know the pain points,” she said. “That is why physicians need to be involved in developing technologic solutions that will help us be better physicians and enhance patient care.”

Additional DermWorld Resources