Teledermatology Toolkit

A-teledermatologyToolkit_300px.jpgAAD's Teledermatology Toolkit offers a host of resources to help you and your practice implement telemedicine, choose a vendor, and connect with AAD experts through an online community.

 

 

  • Overview
    Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.

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    Modalities
    • Store-and-forward: Sending or forwarding of digital images and associated patient data to the specialist for storage and consultation.
    • Live-interactive: Providers and patients interact via live video. A variety of peripheral hardware attachments may be utilized to enhance the consultation.

    Uses
    • Direct-to-consumer: The patient sends images or interacts live, directly with the dermatologist.
    • Triage/consultative for inpatients and outpatients: Another physician sends images or interacts live with a dermatologist for either consultation or triage.

     
     










    This Dermatology World video outlines key considerations for physicians interested in practicing teledermatology.

  • Compliance

     
     

    In this video, Karen Edison, MD, addresses pros and cons of teledermatology — specifically its potential to cut down on follow-up visits for acne patients and bring rising dermatology costs down. This video is a selection from Dermatology World's 2016 debate addressing key issues affecting the future of practice in the specialty.

    Compliance guidance

    If your practice is considering adding a teledermatology service, the following compliance issues must be addressed prior to implementation:

    • Ensure the telemedicine technology you are using is HIPAA-compliant.
    • If you need to install additional hardware or purchase mobile phones to run the telemedicine software on, follow your internal HIPAA security policies on these devices and encrypt PHI.
    • Sign business associate agreements with the telemedicine vendor and any other software/hardware providers who will have access to the PHI.
    • Ensure the telemedicine vendor is compliant with FDA regulations concerning telemedicine and smartphones.
    • Consult the AAD guidelines and AAD teledermatology position statement to ensure you are following appropriate and standard care when consulting with a teledermatology case.
    • Obtain and document informed consent through patient signatures.
    • Maintain documentation of all patient records associated with teledermatology visits for the appropriate length as mandated by state law.


  • Choosing a vendor

    B-Vendors.jpgAfter you have determined that teledermatology interests you, the next step will be to determine which vendor is most appropriate for your practice.  If you currently have an electronic health record (EHR), consult with your vendor to determine if they have a telemedicine offering through your platform. The following EHR vendors have been noted to be the most popular with dermatology practices based on the 2016 AAD HIT survey, and their telemedicine offerings are noted below:*

     Vendor Offers telemedicine software?  More information
    Modernizing Medicine  Yes  https://www.modmed.com/telehealth/
    NexTech  Yes  http://www.dermatologistoncall.com/tag/nextech/
    Epic  Yes Dependent on hospital system providing care
    E Clinical Works  Yes Check with vendor
    Allscripts  Yes Check with vendor

    *Please note that this list solely represents the most-used vendors amongst the AAD membership, and does not imply a recommendation or endorsement of any particular vendor.

    If you do not have an EHR in your practice or your EHR does not offer an integrated telemedicine software solution, consult the following tips to help you select the appropriate vendor:

    • Determine what type of telemedicine offering you want to provide– direct to the patient (please see the AAD Position Statement on Teledermatology), or provider to provider. Then decide whether this will be done via store and forward, or live interactive telemedicine.
    • Try out each vendor’s software to determine which one is best suited to your physicians and clinical staff. Also figure out how much training will be involved with each option, as this will help you determine how easy one product is for your staff compared to another.
    • Calculate all of the costs involved with the vendor including any additional hardware purchases and staff time.
    • If you are interested in live interactive, determine what kind of broadband access you will need and if you will need to upgrade any of your services for that particular vendor.
    • Ensure the vendor is HIPAA-compliant and willing to sign a business associate form.
      If you prefer using your smartphone for telemedicine visits, ensure the vendor offers an app.
    • Try out the vendor’s customer service to determine how helpful it is and which vendor offers the best service.
    • Look at the software from the patient’s experience to determine which vendor offers the easiest platform for your patients to use.

  • Integration

    B-Integration.jpgAfter determining that telemedicine is right for your practice and selecting an appropriate vendor, you should consult the following checklist to successfully integrate the technology into your practice.

    • Determine which staff will play a role in the telemedicine workflow.
      • Assign one administrative staff member to be in charge of scheduling appointments and marketing the new offering to patients.
      • Assign one clinical staff member to be in charge of reviewing communication with patients and notifying the physician when telemedicine cases are needed to be reviewed.
      • Assign one administrative/technical staff member to handle any technical/IT issues.
    • Contact your malpractice carrier to determine appropriate coverage.
    • Determine the best scheduling process for the type of teledermatology you will be performing:
      • For store and forward, the dermatologist has more flexibility and can state he/she will respond within 24 hours of the request so the scheduling process is more open-ended.
      • For live-interactive, follow your practice’s usual scheduling process and put aside a block of time strictly for teledermatology cases.
    • Ensure the patient has been registered in the practice’s billing system and EHR prior to the visit. Collect all relevant clinical and insurance information.
    • The physician commences the telemedicine visit and performs all communication in the HIPAA-compliant software.
    • After the telemedicine visit has completed, the physician should complete all documentation in the patient’s medical record.
    • Administrative staff will file appropriate insurance paperwork if applicable (or charge the patient directly if allowed).
    • If the patient was referred by another physician, send the primary physician a summary of care record electronically or via fax.
    • Follow up with the patient after the visit with an after care survey to determine whether any deficiencies were found with the telemedicine process.
  • Resources

    B-Resources.jpgGetting started guides

    These checklists will help your practice get started in teledermatology:

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    More information about teledermatology:

     

     

     

     

     

     

     

     

     

  • AccessDerm

    AccessDerm BannerAccessDerm

    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 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.

    Download the app

    AAD members and residents who wish to participate can currently download the AccessDerm application for free on the following mobile platforms:

    Participants also can access the program via any Web browser (Internet Explorer, Mozilla Firefox, Google Chrome, Apple Safari, etc.). 

    Where you can use AccessDerm

    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 all 50 states.

    How to participate

    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.

    If you have been involved in this volunteer activity, please log your hours. Logging your hours supports the Academy's efforts to enhance the image of the specialty by promoting your dedication to helping patients, communities and the profession.

    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.

    If you are an AccessDerm participant and are experiencing technical issues, please complete this form and email it to Scott Weinberg at sweinberg@aad.org or fax it to (202) 842-4355.

    As of June 12, 2015, AAD volunteer teledermatology programs have provided 1,611 consults to underserved patients.