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

A majority of our patient population has Medicaid insurance so we are following their requirements and billing guidelines. In addition, our patients are more prone to accepting a visit since their out-of-pocket expenses are low. On the other hand, private practices have limitations with varying insurance coverage with different telehealth regulations and potentially high deductibles. Therefore, the financial concerns are paramount during COVID-19 pandemic.

In the authors’ experience, the main drawback of teledermatology has been poor visual quality, particularly when evaluating pigmented lesions.4 Other challenges of teledermatology include medico-legal liabilities and privacy issues. A physician should ensure that the patient understands the nature and limitations of a teledermatology encounter. Parental consent is required prior to teledermatology visits with minors. Patient photos should be transferred using secured and encrypted services (Table 2).

On the other hand, after establishing teledermatology in our clinic, we realized that the virtual encounter could be an optimum method for many conditions such as acne follow-ups. It allows dermatologists to dedicate more time to counseling and send documents directly to the patient to improve compliance. Often, patients in the office are not aware of the medications they are using and they are able to show it to us on video from their house.

In conclusion, during these trying times with significant uncertainty, dermatologists should be available to provide care for patients with urgent needs and with chronic diseases on systemic treatments. Treating skin disease should not be ignored. The COVID-19 pandemic helps demonstrate the real need to establish a reliable and widely available telehealth infrastructure. Dermatologists should become familiar with teledermatology and incorporate it in their practices. Direct physician examination of the skin outperforms teledermatology in many respects and cannot, at this time, be replaced by teledermatology. However, the technology and infrastructure should be prepared for instances where patients cannot directly access their dermatologists or when the nation faces this kind of crisis or disaster.

The authors have no conflicts to report.

1. Burg G. Teledermatology - its place in modern skin healthcare worldwide. J Eur Acad Dermatol Venereol. 2020;34(4):670-671.
2. Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med. 2020. doi:10.1056/NEJMp2003539.
3. Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice. J Am Acad Dermatol. 2015;72(4):563-574.
4. Finnane A, Dallest K, Janda M, Soyer HP. Teledermatology for the diagnosis and management of skin cancer: a systematic review. JAMA Dermatol. 2017;153(3):319-327.

Mehdi Farshchian MD PhD mfarshch@med.wayne.edu