Telederm: friend or foe

Pearl Kwong, MD, PhD, a pediatric dermatologist in solo practice in Jacksonville, Florida, got the attention of her audience at this year's Society for Pediatric Dermatology meeting with a hilarious introduction. In discussing how often primary care physicians would be calling her (constantly!) during the height of the pandemic, Dr. Kwong said, "I could finally get them to stop calling me all the time when I would answer, 'hello, I'm in the bathroom: what do you want?'"

This lighthearted beginning transitioned into a brief look at the different types of teledermatology available: synchronous (live video visits in real time); asynchronous (store and forward videos); mixed (store and foreward and live); and teledermatology between primary care physicians and dermatologists.

"Telehealth is not a new concept," said Kwong. "Historically, classic examples of where telemedicine was (and still is) ideal are in the fields of radiology, prisoner health care, psychiatry, and home health care." Before COVID-19, however, there was a resistance on all fronts to telemedicine, including a lack of confidence in diagnosis, lack of resources and platforms, insurance reimbursement was not reasonable, and overly-regulated (depending on what state you practiced).

Then, along came COVID-19: usage increased, HIPAA restrictions were lifted, more effective platforms emerged, and both patients and health care providers were adapting.

For dermatologists looking for tips on providing the most effective televisit, Kwong pointed to organizations offering assistance, such as telehealth pages on the AAD, AAP, and SPD websites.

Challenges for practitioners still remain however, such as getting paid correctly (coding issues), images that patients upload (which might be blurred or unclear in some other way), and consideration of HIPAA violations, even with HIPAA relaxing some of its restrictions.

"It can be exhausting talking to a patient who is walking around her house, showing me her messy rooms, walking outside, trying to get a good signal, or not pointing her phone or tablet correctly," quipped Kwong. "The person's ceiing is my most common view on a telehealth call." Other strange venues include a patient's car ("are you actually driving while having this televisit??"), the grocery store, or on vacation in Disney World. "I'm just waiting: any day now, someone is going to schedule a televisit while they are screaming and holding their arms up on Magic Mountain."

Additionally, the lack of human interaction and rapport adds to the challenges of telemedicine, says Kwong, not to mention the eye strain of being on a screen so much. Nevertheless, Kwong notes telederm also means less time out of school for a patient, one can make a last-minute appointment, less time off work for the parents, and "no need to wear masks on both ends: you can see the whole face of your patient!" There is also, during waves of viruses, like COVID-19, less chance of infection for both patient and practitioner.

Bottom line, Kwong summed up: teledermatology is here to stay with both its benefits and challenges. Future research is still needed to optimize the technology, policies and regulations need to be reviewed and established, and more education is neeeded to train all practitioners in the rules and regulations of teledermatology.

Reference

Kwong P. Teledermatology: friend or foe. SPD 2022 47th Annual Meeting. July 8, 2022. Indianapolis, Indiana.