A Dermatologist Looks at the Challenges of Telehealth Adoption
A practicing dermatologist has examined some of the issues facing potential advances in telehealth in the specialty of dermatology. Jules B. Lipoff, M.D., an assistant professor of clinical dermatology and a practicing dermatologist at Penn Medicine in Philadelphia, on Oct. 14 published an article in the Health Affairs Blog entitled “As Telehealth Surges, Dermatology Brings Experience With Access And Sustainability.”
As Dr. Lipoff notes, telehealth adoption has surged during the COVID-19 pandemic; but that the rapid transition “has left many physicians grappling with how to integrate and adapt telehealth into their workflows.” But what about in the field of dermatology? “Even though telehealth usage was minimal before the pandemic, dermatologists are no stranger to its potential, with a large body of teledermatology research with both store-and-forward (shared digital photographs) and live-video models,” Lipoff writes. “In fact, dermatologists helped pioneer telemedicine in the 1990s, using it to effectively treat patients in rural and underserved communities. Hon Pak, MD, FAAD, MBA, and Darryl Hodson, MD, FAAD, launched the country’s first robust teledermatology project in 2000 for the US Army, growing it to provide consultations for service members and their families in more than 50 countries. Technology has evolved significantly since then—including the ubiquity of smartphones in patients’ hands—but the early lessons they learned and procedures they established, such as the need to train dedicated telehealth coordinators and build strong relationships with primary care providers, paved the way for the sophisticated telemedicine systems we use today. Building on that momentum, during the pandemic, dermatologists have been implementing telemedicine and sharing insights with colleagues in other specialties to continue effectively delivering high-quality care.”
So what are some of the challenges facing dermatologists right now, in that context? When it comes to his specialty, Lipoff notes, “Clinical and administrative staffs’ workflows and preparations are different for telehealth versus in-person visits, the appropriateness of telehealth for each visit must always be assessed, and patients’ comfort and competency with virtual platforms varies. Tasks such as sharing health information with patients and even the billing process are all different and require flexibility and adaptability by physicians, staffs, and patients alike. We must especially be aware of the risks to those with the least access to virtual care; the well-known digital divide could worsen disparities for the most vulnerable populations, who may not have access to broadband internet connections needed for video visits.”
And, “While patient preference remains paramount, some care cannot be provided remotely: procedures (for example, biopsies, surgeries), full physical examinations (for example, total body skin exams), and advanced treatments that are only deliverable in clinical settings,” Lipoff underscores. “Still,” he says, “telemedicine remains most potent in its ability to triage care, manage existing chronic conditions, and care for patients from a distance—such as when a patient lives far from their specialist or is quarantined. For providers and policy makers, the prime consideration must be how to best deliver high-quality care for everyone. This demands careful consideration of the balance between telemedicine visits and in-person visits, maintaining strong physician-patient relationships, and ensuring delivery of the right care at the right time.”
The challenges are multi-faceted, Lipoff emphasizes. But he urges patient care organization leaders to keep moving forward to integrate telehealth strategies into their practices; and he adds that federal health officials must allow physicians delivering telehealth services to be licensed in the states in which patients live. He adds that the original Medicare program and Medicare Advantage “should not create unintended barriers to high-quality care by limiting in-person interactions between the patient and physician. And demographic data should be collected and examined to ensure that telehealth narrows the gap in health disparities and adequately addresses social determinants of health.”
In the end, Lipoff says, “The COVID-19 pandemic will likely be a turning point in health care as a whole, with increased telehealth use in the long term for dermatology and all of medicine. Physicians, insurers, and policy makers must collaborate and share key COVID-19 telemedicine lessons learned to leverage this technology’s promise to increase efficiency, convenience, and access to specialists for patients across the country.”
