Teledermatology Toolkit

The Academy's teledermatology resources can help you implement telemedicine and learn innovative ways to improve access for your patients

  • Overview
  • State regulations
  • Compliance & implementation
  • Resources
  • Member stories
  • AccessDerm

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Overview

Recently, a combination of advancements in information technology (IT), including electronic health records (EHRs), high-definition video conferencing, remote patient monitoring, mobile devices and networks, and ubiquitous broadband networks, has created an opportunity to leverage telehealth services to improve our national health care system. Health care workers can use this technology to provide clinical services to patients, to monitor patient health, to consult with other health care providers, and to provide patients access to educational resources.

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Importantly, the technology has reached the point where, in many situations, health care providers can use IT to offer quality clinical health care services remotely. For example, the widespread adoption of mobile devices, as well as the deployment of mobile broadband networks, means that a large number of Americans have access to low-cost, high-quality video conferencing capabilities. While telehealth services will certainly not replace in-person clinical visits, they have the potential to serve as an additional tool for caring for patients.

The Center for connected Health Policy’s (CCHP) annual State Telehealth Laws and Reimbursement Policies report offers the nation’s most current summary guide of Medicaid provider manuals, applicable state laws, and telehealth-related regulations for all fifty states and the District of Columbia. This report serves as a vital resource for health care professionals on how each state defines, governs, and regulates technology-enabled health care, noting policy trends across eleven key categories as indicated in the 50 State Scan of Telehealth Reimbursement Laws and Medicaid Policies - Factsheet.

What are the key elements of telemedicine?

  1. Provide clinical support.
  2. Overcome geographical barriers, connecting patients with providers who are not in the same physical location.
  3. Implement the use of various types of technology such as synchronous and asynchronous video clinical encounters, store and forward transmission of health data, and remote patient monitoring.
  4. Facilitate value-based care and improved patient outcomes.

What are the benefits of telemedicine?

  • With telehealth technologies, providers can deliver quality care at a lower cost, a critical imperative in the accelerating era of value-based payment. Other key benefits are profiled below.
  • Increasing access to care and reaching new markets by enabling virtual consultation regardless of geographic location.
  • Addressing misdistribution of subspecialists.
  • Reducing emergency department visits preventing overcrowding and significantly lowering health care costs.
  • Addressing problems quickly before they become more serious.
  • Lowering health care costs as remote medical encounters are less expensive than in-person visits.
  • Facilitating patient compliance with referred care and recommended treatment plans.

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What are the telemedicine rules in your state?

Find out with this interactive map.

view MAP

Tab 3

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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 in accordance with state law.
  • Maintain documentation of all patient records associated with teledermatology visits for the appropriate length as mandated by state law.
  • Ensure that the provider is legally permitted to practice medicine in the state where the patient is located.


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Choosing a vendor

There is more than one way to introduce teledermatology to your practice. Below are options for you to consider when selecting how your practice will participate in teledermatology.

Teledermatology using an EHR

Certain Electronic Health Record (EHR) vendors will offer a telemedicine option in their portfolio of service offerings.  Consult with your vendor to learn how to utilized their telemedicine platform.

Teledermatology without an EHR

If you do not have an EHR in your practice or your EHR does not offer an integrated telemedicine software solution, consider working with an external vendor. Below are tips in selecting an appropriate vendor for your practice.

Try out each Telemedicine vendor’s platform to determine which one is best suited to your physicians and clinical staff. Questions to consider:

  • Does the vendor provide staff training?
  • If you prefer using your smartphone for telemedicine visits, does the vendor offer an app?
  • Does the platform allow the clinician to collect relevant medical history, and provides easy opportunities to ask follow-up questions of the patient to obtain additional history?
  • Does the platform have the capability to send lab studies local to the patient when needed?
  • What are the costs involved with the vendor including any additional hardware purchases and staff time?
  • If you are interested in live interactive, what kind of broadband access will you need? Will you need to upgrade any of your services for that particular vendor?
  • Is the vendor HIPAA-compliant and willing to sign a business associate form?

It is also recommended that you try out the vendor’s customer service to determine how helpful it is and which vendor offers the best service. Finally, look at the software from the patient’s experience to determine which vendor offers the easiest platform for your patients to use.

To learn more about the AAD and Teledermatology position read the AAD Position Statement on Teledermatology.


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Implementation

After 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.

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B-Resources.jpgGetting started guides

These checklists will help your practice get started in teledermatology:


Fundamentals of Teledermatology online course

The Academy offers a complimentary Fundamentals of Teledermatology course in the Online Learning Center (OLC). In the OLC search box, enter "Fundamentals of Teledermatology" to access the course.


More information about teledermatology:

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COMING SOON! Call the AAD's practice support line.

Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.


 
 
 
 
 
 
 
 

icon-for_patients.pngJoin the community

Post them to the Teledermatology Community and AADA expert staff and members will find the answers.

JOIN THE DISCUSSION

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How dermatologists have found uses for telemedicine around the world and at home

Advances in teledermatology enable dermatologists to remotely diagnose skin conditions and potentially recommend treatments for patients halfway around the globe, as well as those closer to home.

The technology, experts say, exists to make either store-and-forward or live interactive teledermatology workable. Dermatology World recently featured the the stories below. In these vignettes, AAD members share their experiences regarding how far the technology has come and their vision for the future.

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Extending care to underserved populations

Carrie Kovarik, MD, associate professor of dermatology, dermatopathology, and infectious diseases at the University of Pennsylvania, began working with the Baylor International Pediatric AIDS Initiative in 2006, when she was a fellow. The program provided patient care, treatment, and education on pediatric AIDS care throughout Africa.

“These clinicians were doing a great job taking care of the human immunodeficiency virus (HIV), but at the same time half of their patients were coming in with complex skin conditions that they weren’t sure how to manage,” Dr. Kovarik said.

She traveled to Baylor sites in Uganda, Malawi, Lesotho, Swaziland, and Botswana to lecture to clinicians and train them on telemedicine, using an Internet-based Web portal that she and a colleague from Uganda developed.

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Embracing the benefits of teledermatology for U.S. populations

Observing the inroads in overseas teledermatology, William James, MD, vice chair and director of the residency training program at Penn, recognized the technology’s potential in underserved populations in the U.S. “There were a lot of people who either couldn’t afford care or couldn’t access it for a variety of reasons,” said Dr. James, who served as president of the American Academy of Dermatology (AAD) from 2010 to 2011.

As president-elect, Dr. James worked with the AAD to explore free health care clinics, including free consultations from dermatologists. He and his colleagues began a pilot program at two Philadelphia clinics. “We were able to provide the same kind of service that we could to overseas people in need, and the Academy was very supportive,” he said.

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Teledermatology in the military

Teledermatology began to emerge in the military approximately two decades ago. During the Bosnian War, clinicians in Bosnia sent digital images of skin conditions via FTP, said Hon Pak, MD, chief medical officer at Longview International Technology Solutions, Inc., who was a medical resident at Walter Reed Army Medical Center at the time. Prior to teledermatology, retrieved images were printed and taken to the dermatology clinic to be read.

With the Internet boom, Dr. Pak began developing the concept of a store-and-forward teledermatology consult. He and his colleagues designed the software and deployed it to the military using grant funding.

“With the military being in every time zone, we don’t have enough dermatologists to be everywhere the soldiers are,” said Dr. Pak, who is retired from the U.S. Army. Teledermatology provides time and distance advantages when conditions such as leishmaniasis or anthrax require rapid diagnosis and management recommendations from trained dermatologists.

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Expanding possibilities

Because of difficulties in transporting inmates to outside medical facilities, teledermatology offers valuable advantages in the prison system. In 2014, the Federal Bureau of Prisons completed 750 teledermatology consultations.

The Federal Bureau of Prisons reported that its teledermatology program saves the prison system money and speeds the time to consult. The teledermatology program also improves patients’ access to care and continuity of care.

Teledermatology is used easily for diagnosis in this type of setting, said Karen Edison, MD, chair of the department of dermatology at the University of Missouri, Columbia, and medical director of the Missouri Telehealth Network, who has provided teledermatology services to a Missouri hospital that admits maximum-security and intermediate-security clients.

pre_auth_hotline_icon.pngNeed help? Call the AAD's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

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AccessDerm

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 download the AccessDerm application for free on the following mobile platforms:

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iPhone and iPad
   
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Participants also can access the program via any Web browser (Internet Explorer, Firefox, Google Chrome, 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. 

Technical troubles?

If you are an AccessDerm participant and are experiencing technical issues, please complete this form.

Need help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1