By Carrie Kovarik, MD, FAAD
It sounds futuristic, but telemedicine — the use of telecommunications technologies to diagnose and treat patients — has been hotly anticipated at least since 1993, when the American Telemedicine Association (ATA) was established. Now, it is a significant and rapidly growing component of health care in the United States. According to the ATA, more than 20 million Americans get some part of their health care remotely, and that number will grow as telemedicine expands its reach.
The Academy was an early adopter of telemedicine. Since launching its first program in 2009, AAD volunteers have made more than 1,000 consults via Academy-sponsored teledermatology programs, more than half of which have been made since the launch of the Academy’s AccessDerm app.
AccessDerm is an Academy-sponsored teledermatology program that allows AAD dermatologists to provide care to underserved populations in the United States. By participating in the program, members and residents can consult remotely on dermatology cases using mobile devices and the Internet. The AccessDerm program gives primary care providers (PCPs) who work in participating clinics free access to AAD dermatologists’ expertise. Primary care clinicians submit consultations that dermatologists then receive on their personal mobile devices or the Internet via HIPAA-secure and compliant means.
The Academy’s teledermatology concept came together under then-Academy President William James, MD, who aimed to improve volunteerism and access to dermatologists. At the time, I was practicing telemedicine to help underserved populations globally, and I brought what I learned to help shape this Academy-sponsored program.
I first started practicing teledermatology in 2006 with a web-based program in collaboration with the Baylor International Pediatric AIDS Initiative (BIPAI) in Africa. Together with partners at the Medical University of Graz, including Dr. Steven Kaddu, we developed a teledermatology web site to help diagnose and manage HIV-related cutaneous diseases. This program assisted the local primary care providers who were being inundated with skin issues and proved to be a success in urban centers that had access to computers, but not in more remote areas without Internet. However, by 2008, cell phones became more widely used, which provided an opportunity for expanded use of telemedicine.
This concept was embraced by the Academy, which sought to sponsor a teledermatology program in the United States. We launched a pilot program in August 2009 with two clinics in Pennsylvania. Even though that was only five years ago, our method for transmitting data seems almost primitive by today’s standards. The pilot clinics would use cell phones to text clinical information to volunteer dermatologists and send photos of the skin condition separately. The process was a bit onerous, but it proved that the program could work.
In 2010, when the Android smartphone started to gain widespread popularity, we used it to launch a national teledermatology program with 27 sites. We recruited AAD members willing to reach out to local clinics. Many of these members were already volunteering in their communities, but didn’t really have the time to log in hours physically at the clinics. The program provided these members a more efficient way to offer dermatologic care to the underserved.
In its initial two years, almost 500 consults were made through the program and we learned a lot about establishing successful relationships with clinics. For example, we discovered that in order for the program to be useful, a clinic had to rely on the program as part of their regular workflow or else they rarely used it after the initial training period. About a third of the clinics in the first year utilized AccessDerm on a regular basis.
By 2012, smartphone technology and the use of apps had advanced greatly, which led to the development of the Academy’s current AccessDerm program. The AccessDerm app streamlined the teledermatology process, making the program easier for clinics to use and less expensive for the Academy to operate. Since the launch of the app, we’ve doubled the number of consults and recently reached the milestone of our 1,000th consult.
The program has demonstrated some unexpected benefits, including offering an excellent training opportunity for young physicians. In my group at the University of Pennsylvania, the program is serviced primarily by residents and attendings. The typical case takes them less than five minutes of consult time and exposes them to most of the skin conditions typically seen in a primary care clinic. During a busy week, my group consults on about 10 cases. So, in exchange for a small time commitment, we’re providing an invaluable service.
AAD members can now indicate in their AAD member profiles that they use teledermatology. Using the member directory telemedicine drop-down selection, members can search for and connect with colleagues who practice teledermatology. To indicate your teledermatology use, edit your member profile here.
Another benefit is that the program allows members to build stronger relationships with PCPs in their area, a powerful opportunity in the age of Accountable Care Organizations (ACOs). We’ve found that PCPs really enjoy the service. In fact, when my group performed a study on scaling up the program in Philadelphia, we required PCPs to enroll patients in the program, which required a lot of training and paperwork, and we still managed to recruit 85 physicians.
With the success of AccessDerm, we’re looking for innovative ways to expand the program. Currently, the program is focused on linking uninsured patients in an underserved clinic to an academic center. But we’d like to expand opportunities for both members and patients. For example, we’re looking at the possibility of offering the program to elderly patients who can’t easily travel for a post-op visit.
AAD members and residents who wish to participate can download the AccessDerm application for free on the following mobile platforms:
• iPhone and iPad
Participants also can access the program via any Web browser (Internet Explorer, Mozilla Firefox, Google Chrome, Apple Safari,etc.).
Due to licensure requirements, an AAD dermatologist only can provide remote consultation on cases that originate in a state where he or she is licensed. AccessDerm is currently being used in 16 states, however, the Academy seeks to increase participation by clinics in other states.
If you are an AAD member who wishes to participate,and/or you would like to recommend a primary care clinic in your area for participation in the program, please submit your contact information.
Dr. Kovarik is an Associate Professor of Dermatology, Dermatopathology, and Infectious Diseases at the University of Pennsylvania. She is chair of the AAD’s Telemedicine Task Force.
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