Atopic Dermatitis: a Short Summary
Teledermatology: Practical Approach (For Professionals)
Setting up a teledermatology service
Why do teledermatology ?
- It bridges the gap between medical specialists and patients. It can act at any distance and the asynchronous (store and forward) mode is also time independent.
- It brings specialist competence in underserved areas
What are the considerations when setting up a teledermatology?
It depends on the mode of teledermatology:
Synchronous Mode (Live or Real time):
- characteristics: enables direct interaction: explanations and questions are addressed immediately
- requirements: videoconference (10-15000USD), exam cameras (medical 5-6000 USD, consumer market 600-1800 USD), dedicated internet connection, secure internet connection (minimum 384 Kpbs bandwidth), manpower*
*coordinator to operate camera (time consuming as many captures are often needed), scheduling staff, general practioners/primary care providers on site optional) Troubleshootiing referents.
- How to do a consult?
- Room setup: seating arrangement, confidential communication
- Consent signed before
- referral by GP or colleague
- Medical records: do not record all the encounter (a lot of info but memory problems are becoming less of an issue)
- Follow up ?
- teledermatology or face to face
- Problems ?
- Image quality
- high technology cost
Asychronous Mode (Store and forward)
- characteristics:
- indirect interaction
- cheaper and is therefore more widely used and increasing than real time.
- useful tool for triage (determining the more complex dermatological cases than the more trivial ones)
- geographical location is unimportant (as long as internet connection); signed consent before initiation of encounter; referred by GP (Primary care physician); explanation to patient (its a bit like an Xray session, no encounter with dermatologist)
- How does the consultation take place:
- coordinator asks questions
- coordinator takes pictures
- coordinator sends file
- dermatologist comments and sends recommendations back
- requirements:
- digital cameras (SLR or hand held): resolution is no longer an issue (10 megapixels or highr), macropicture, image stabilizer, image acquired with ambient light (non flash) lighting
- secure data transmission application (Teledermsolutions, Second opinion, Medweb, AFHCAN)
- most importantly, a skilled photographer*
- the referring physicians will have take the time to explain things such as the diagnosis and treatment because the dermatologist won’t be able to do it directly so.
*How to take a picture:
- Close up with ruler next to lesion
- Standardized picture for distribution (front, back, lateral right and lateral left)
- Draw lesion location on body diagram
Contributors:
Dr Christophe HSU – dermatologist. Geneva, Switzerland
Armstrong A – Teledermatology 101. 69th Annual Meeting of the AAD (American Academy of Dermatology) – New Orleans, Louisiana, United States of America (USA)
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