Recommendations for Dermatology Office Reopening in the Era of COVID-19

July 2020 | Volume 19 | Issue 7 | Original Article | 22 | Copyright © July 2020

Published online June 26, 2020

Suleima Arruda MDa, Doris Hexsel MDb, Tingsong Lim MDc, Heidi A. Waldorf MDd, Ofir Artzi MDe, Whosung Choi MDf, Sahar Ghana MD PhDg, Huang Gaomin MDh, Wilson Ho MDI, Maria Cristina Puyat MDj, Elena Rossi MDk, Ava Shamban MDl, Sonja Sattler MDm, Neil Sadick MDn

aArruda Dermatology, Sao Paulo, Brazil bBrazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil cClique Clinic, Kuala Lumpur, Malaysia dWaldorf Dermatology Aesthetics, Nanuet, NY; Icahn School of Medicine of Mount Sinai, New York, NY eTel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel fPiena Aesthetic Clinic, Seoul, Korea gAlexandria University, Alexandria, Egypt; Sahar Polyclinic, Salmiya, Kuwait hShanghai WanTian Cosmetic Medical Management Consultancy, Shanghai, China iThe Specialists: Lasers, Aesthetic and Plastic Surgery, Central, Hong Kong jRizal Medical Center, Pasig, Philippines kHead and Neck Skin Cancer Service, Modena, Italy; Reggio Emilia University, Modena, Italy lAva MD, Santa Monica, CA; SKIN FIVE, Los Angeles, CA mRosenpark Klinik GmbH, Clinic for Aesthetic Dermatologic Surgery and Plastic Surgery, Darmstadt, Germany, nWeill Cornell College of Medicine, New York, NY

around the globe face similar challenges as they face the ‘new normal’ of evaluating and treating patients in the time of COVID. Indeed, as lockdowns are lifted, social distancing measures are relaxed, and patients’ demand for both standard dermatologic care and aesthetic treatments returns, dermatologists worldwide recognize they will need to resume a new operational modus operandi, one in which preparedness and emergency policies are hardened against known and new biological risks. As practices open, fully new, as yet unknown, issues around liability and other legal and public health obligations may arise. While guidance is an evolving scenario that is updated by local ministries of health to reflect new information and considerations, there is a dire need for a roadmap dermatologists can follow as they resume operations, to safely and effectively treat their patients without compromising clinical outcomes, overutilize precious resources, or suffer additional financial losses. Medical associations around the world have provided “physician practice guides for reopening” on their websites. Multispecialty groups of physicians and surgeons have recently published some recommendations specific to aesthetic specialties and procedures.4-6

In recognition of this gap of knowledge for dermatologists and taking into consideration that COVID-19 government responses around the world have been nuanced, a group of international experts was assembled to formulate guidance and best-practices for resuming dermatology practices in a COVID- 19 era. Participants included individuals from Europe, North America, Latin America, and Asia, with a balanced spectrum of professional seniority and expertise. Experts convened via videoconferencing on three separate occasions and collectively designed an outline describing new guidelines, policies, and protocols that may be utilized to resume practice with a completely revised operational standard. Each member contributed to the recommendations, which were backed up by the best available research evidence identified by PubMed searches with MeSH terms. The recommendations include considerations for new organizational policies and practical guidelines for dermatology practices as the corona pandemic continues. A personal perspective of each experts’ experience from different countries of origin is also included. The recommendations are not to replace federal, state or local government laws, which have to be obeyed.

Pre-Opening Planning
Digital Footprint: Website, Social Media, etc.
All online avenues of the dermatology practice (website, newsblasts, social media) need to be harnessed and have their messaging adjusted in an informative yet positive manner. Communication should the unique ability of specialty dermatology practices to provide the safest environment for their dermatologic needs. It is important to prepare patients for each clinic’s new standards of practice in response to the COVID-19 outbreak. Clear instructions should be sent prior to arrival and include the relevant details of the clinic practice preparedness plan including expectations for patient behavior – utilizing hand washing stations, required mask wearing, and others, and what to expect regarding practice flow through the office and physician and staff PPE. Understanding the clinic regulations and their own responsibility in this setting can both reduce patient anxiety upon entry and aid staff to maintain stringent infection control. All the new policy and protocols should be clearly displayed at office entry, throughout common areas, treatment rooms, and in bathroom. Clearly visible and easily understandable visual images are particularly helpful for these posted protocols.

Consider integrating telemedicine in your practice. While this may not be an answer for every practice, it has proven to be successful in various settings.7 “Telemedicine” is a term that covers any use of electronic communication technology to convey medical information. While previously promoted as an opportunity to expand healthcare access rural and underserved populations, telemedicine has been aggressively adopted as a safer means to provide medical care during the COVID-19 pandemic. In addition to minimizing office traffic and contact time and, thereby, reduce the potential risk of infectious disease transmission, telemedicine has been shown to achieve similar health outcomes compared with in-person patient visits in several studies and can have additional benefits including reducing travel costs and time away from work. The contact time in the office can then be limited to what is needed for examinations and procedures that may not be done virtually. In the USA, the government has temporarily waived compliance with strict patient privacy regulations to increase accessibility of telemedicine during the COVID-19 pandemic. Prior to using publicly available applications such as FaceTime, Skype, and Zoom, or specific electronic health portals, to provide telehealth remote communications with patients, physicians should check their country’s applicable government regulations. The ability to collect payment from patients for these visits and the relevant coding and documentation needed must also be checked with national healthcare agencies.8-10

Necessary for successful telemedicine integration may include an electronic medical record system infrastructure, audiovisual platforms, necessary hardware, coding/billing integration, and information technology (IT) support. Training on both the side of the physician (providers, assistants, schedulers, and billers) and the patient (patient and/or caregiver) is also critical to allow adequate visibility during each virtual examination. In some cases, a small investment by the patient in a home device such as a simplified Bluetooth dermatoscope and home diagnostic lab kits may be required. The most easily integrated telemedicine visits are: