Teledermatology: Introduction (For Professionals)

Teledermatology: Introduction (For Professionals)

Some numbers

• The world has 8 million physicians (medical doctors) and therefore idealy, there would be 124 doctors for 100000 people.
• However, there are only 2% of all physicians are in Africa.

• Regarding dermatologists, it is estimated that ideally, there would be one dermatologist for 50000 people.
• However, there are huge disparities, most notably between developing countries and industrialized countries, as well as urban and rural environments. For example in India, there is one dermatologist for 226000 people in rural areas, whereas in cities, this number increases to one dermatologist per 150000 people. In Subsaharian Africa, the situation is dramatic, with one dermatologist for 1 million inhabitants and in some areas of South Africa, there is one dermatologist for 1 to 1.2 million people.

Who uses teledermatology ?

• Developing countries (Universities, Governments…) (example: email teledermatology service between Australia and Iraq, Dermatology and dermatopathology telemedicine between Switzerland and Cambodia)
• Public Health Services (for example in Alaska to service isolated populations)
• Army medical services (for example Serbia…)

What are the different ways of doing teledermatology ?

• synchronous mode (real time)
• asynchronous mode (based on stored data)

Problems with teledermatology

• lack of directly delivered information
• patients do not come back for follow-up
• less clinical certainty in the diagnosis which ultimately increases the rate of performing biopsies
• A certain diagnosis does not enable to enact recommended changes (for example erythema ab igne diagnosed in a Pakistani woman cooking for her family will probably not change her daily routine)
• Also because of sometimes very limited financial means, the diagnosis is clinical and cannot be confirmed with lab tests or biopsies (example: erythropoietic protoporphyria in Pakistan)
• Problems with reimbursement and other medico-legal issues.

What are the advantages of teledermatology ?

• the principal plus is that the waiting time for the patient is reduced due to an improvement in triage between trivial and potentially problematic cases.
• the duration of a teledermatology consult is only 7.2 minutes (synchronous mode) (whereas the “head-to-head” consultation lasts 24 minutes in average)
• Good for areas where the population is scattered out.

What is the main thing which enable to do teledermatology (or generally speaking telemedicine) ?

• It is the degree of access to the internet (availability and connection speed):

1. in America (USA), Oceania (Australasia) or Europe, at least 60% of the population has access to the internet.
2. in Africa, this number is a measly 11% !

Who does teledermatology ?

• Governments (NHS (National Health Service), Military, promotion of underserved regions) (India, Canada, New Zealand (there are only 40 dermatologists in this country !)), private individuals +, commercial enterprises* (KYSOS company in the Netherlands: it is profitable baucouse teledermatology is reimbursed, it has done 40000 consults, it reduces cost by 65-70% because less patients are referred inadequately)

*: ederm, live person, doctors pro, iDoc24, dorm derm ! (for acne)

+ Ian McColl: free consults for colleagues in Australia

How to contribute ?

• telederm.org…AAD sponsored (overseas volunteers, Africa teledermatology project)
• New programme for South America (piel-telederm.org)

Next world congress of teledermatology

• Tbilissi, Georgia in 2012

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

McKoy K – Overview of International Teledermatology. 69e Réunion annuelle de l’AAD (American Academy of Dermatology) – New Orleans, Louisiana, United States of America (USA)