Teledermatology: Practical Approach (For Professionals)

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?

1. Room setup: seating arrangement, confidential communication
2. Consent signed before
3. referral by GP or colleague
4. Medical records: do not record all the encounter (a lot of info but memory problems are becoming less of an issue)

• Follow up ?

1. teledermatology or face to face

• Problems ?

1. Image quality
2. high technology cost

Asychronous Mode (Store and forward)

• characteristics:

1. indirect interaction
2. cheaper and is therefore more widely used and increasing than real time.
3. useful tool for triage (determining the more complex dermatological cases than the more trivial ones)
4. 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:

1. coordinator asks questions
2. coordinator takes pictures
3. coordinator sends file
4. dermatologist comments and sends recommendations back

• requirements:

1. 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
2. secure data transmission application (Teledermsolutions, Second opinion, Medweb, AFHCAN)
3. most importantly, a skilled photographer*
4. 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)