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Outpatient Teledermatology Implementation During the COVID-19 Pandemic: Challenges and Lessons Learned

June 2020 | Volume 19 | Issue 6 | Features | 683 | Copyright © June 2020


Published online May 14, 2020

Mehdi Farshchian , Geoffrey Potts , Arash Kimyai-Asadi , Darius Mehregan , Steven Daveluy

aWayne State University Department of Dermatology, Detroit, MI bDerm Surgery Associates, Houston, TX

Abstract

INTRODUCTION

Telehealth utilizes communication technologies to provide health care services remotely. Teledermatology, which was first established to deliver health care to areas where there is a dire shortage of medical dermatologists, is based on the fact that visual inspection is one of the hallmarks in the diagnosis of dermatologic diseases.1 The recent COVID-19 pandemic created a sudden need for teledermatology to facilitate patient care while maximizing social distancing to slow down spread of the virus.2

Widespread access and rapid developments in mobile phone applications have revolutionized teledermatology. Currently, there are three different teledermatology modalities: store-and-forward; real-time with direct phone or video calls; and hybrid, which combines both methods.3

In our university-based practice, teledermatology was previously limited to the John D. Dingell Veterans Affairs Hospital and Michigan Department of Corrections. However, the COVID-19 pandemic forced us to establish an efficient and feasible way to perform teledermatology. We assessed each step in our process including revenue cycle management. While the physicians were ready to provide care, our registration, check-in, and billing process required consideration to ensure revenue capture (Table 1). The next step was to select a platform meeting all of the requirements for the patient and physician. We initially chose Google Hangouts, which allows transmission of high-resolution photographs to overcome the challenges of low-resolution video in assessing skin problems. It presented a challenge for patients in establishing an account and accepting invitations. Hence, we changed to HIPAA-compliant Doximity, which only requires the patient click a link sent via an encrypted and private text message. Established in 2011, Doximity is one of the most user-friendly medical social network tools utilized to communicate with patients and other providers. Physicians can make phone calls to patients without sharing their personal contact information. We are using a recently added video call feature that enables real-time teledermatology encounters in a secure environment whether on the computer or smartphone. In addition, group video calls are helpful in training settings, where residents and attendings evaluate patients simultaneously. In our teledermatology setting, patients are first seen by our residents and then attending dermatologists join the virtual encounter to review and confirm the diagnostic and treatment plan. This continues some semblance of normalcy for our physicians, patients, and trainees in this difficult time.

More than 77% of our encounters are being performed by teledermatology except for patients requiring urgent procedures.