Teledermatology Platforms Usage and Barriers: A Cross-Sectional Analysis of United States-Based Dermatologists Pre- and Post-COVID-19

February 2024 | Volume 23 | Issue 2 | e64 | Copyright © February 2024


Published online January 24, 2024

Justin W. Marson MDa, Rebecca M. Chen MDa, Maham Ahmad BAb, Graham H. Litchman DO MSc, Sara Perkins MDb, Darrell S. Rigel MD MSd

aDepartment of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY
bDepartment of Dermatology, Yale University School of Medicine, New Haven, CT
cDepartment of Dermatology, St. John’s Episcopal Hospital, Far Rockaway, NY
dDepartment of Dermatology, Mt. Sinai Icahn School of Medicine, New York, NY



the fact that a greater percentage of EAs than CAs reported using platforms capable of asynchronous teledermatology (ie, uploading images), that allowed staff to join visits and required an "app" to use. 

Image quality was highlighted as the greatest concern materially more often by CAs/NAs. Although our prior study indicated no material regional difference between EAs and CAs/NAs,13 it is unclear how available mobile devices, mobile applications, and access to broadband internet play a role, especially among rural/lower socioeconomic patient populations with other barriers to healthcare access.15 While asynchronous/SAF teledermatology can potentially partially mitigate these concerns, our previous study has found this method to be underused by ~50% of actively practicing US dermatologists.13

Of note, >30% of CAs reported using platforms without, at the time of writing, known integration with electronic medical records (EMRs), while 17.8% reported using Facetime as their current primary platform, which is not currently Health Insurance Portability and Accountability Act (HIPAA)-compliant. With the end of the COVID-19 public health emergency (May 11, 2023), covered healthcare providers have had until August 9, 2023, to transition to HIPAA-compliant platforms.14 This may disproportionately affect private dermatologists and their ability to provide care to their patients.1,5,13,16

As CAs are disproportionately private dermatologists (a group that represents 80-90% of the current actively practicing US dermatologist workforce), it is important to understand the (evolving) role of technology in their practices.5,16 With the end of the COVID-19 public health emergency, this may be an opportunity for CAs to expand their use of teledermatology, and adopt HIPAA-compliant platforms and additional modalities to care for all patient populations. 

Limitations include retrospective study and response bias, with limited responses from NAs/rural dermatologists.

CONCLUSION

Our study demonstrates that teledermatology usage and implementation vary and correlate with when the technology was incorporated into US-based practices. Future studies should aim to investigate barriers to implementation, as well as how these barriers and teledermatology have impacted and may impact equitable access to dermatologic care.

DISCLOSURES

JWM has served as a Digital Health Fellow and an advisory board member for Doximity, Inc. RMC, MA, GHL, SP, and DSR have no relevant disclosures or conflicts of interest to declare.
IRB approval status: reviewed and granted exempt status by Advarra IRB; approval #Pro00060440

REFERENCES

  1. Litchman GH, Marson JW, Rigel DS. The continuing impact of COVID-19 on dermatology practice: office workflow, economics, and future implications. J Am Acad Dermatol. 2021;84(2):576-579. doi:10.1016/j. jaad.2020.08.131. 
  2. Loh CH, Chong Tam SY, Oh CC. Teledermatology in the COVID-19 pandemic: a systematic review. JAAD Int. 2021;5:54-64. doi:10.1016/j.jdin.2021.07.007. 
  3. Snoswell C, Finnane A, Janda M, Soyer HP, Whitty JA. Cost-effectiveness of store-and-forward teledermatology: a systematic review. JAMA Dermatol. 2016;152(6):702-708. doi:10.1001/jamadermatol.2016.0525. 
  4. Lee JJ, English JC 3rd. Teledermatology: a review and update. Am J Clin Dermatol. 2018;19(2):253-260. doi:10.1007/s40257-017-0317-6. 
  5. Ehrlich A, Kostecki J, Olkaba H. Trends in dermatology practices and the implications for the workforce. J Am Acad Dermatol. 2017;77:746-752. doi:10.1016/j.jaad.2017.06.030 
  6. Zachrison KS, Yan Z, Samuels-Kalow ME, et al. Association of physician characteristics with early adoption of virtual health care. JAMA Netw Open. 2021;4(12):e2141625. doi:10.1001/jamanetworkopen.2021.41625 
  7. Eberly LA, Kallan MJ, Julien HM, et al. Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic. JAMA Netw Open. 2020;3(12):e2031640. doi: 10.1001/jamanetworkopen.2020.31640. 
  8. Rashek Kazi, Maria R. Evankovich, Rebecca Liu, et al. Utilization of asynchronous and synchronous teledermatology in a large health care system during the COVID-19 pandemic. Telemed e-Health. 2021;27(7):771-777. http://doi.org/10.1089/tmj.2020.0299. 
  9. Asabor EN, Bunick CG, Cohen JM, et al. Patient and physician perspectives on teledermatology at an academic dermatology department amid the COVID-19 pandemic. J Am Acad Dermatol. 2021;84(1):158-161. doi:10.1016/j. jaad.2020.09.029. 
  10. Lu D, Webb A. Pitfalls of telehealth in the management of skin cancer: a COVID-19 perspective. Australas J Plast Surg. 2020;3(2). doi:10.34239/ajops.v3n2.241 
  11. Perkins S, Cohen JM, Nelson CA, et al. Teledermatology in the era of COVID-19: experience of an academic department of dermatology. J Am Acad Dermatol. 2020;83:e43-e44. doi:10.1016/j.jaad.2020.04.048 
  12. Ahmad M, Marson JW, Litchman GH, et al. Usage and perceptions of teledermatology in 2021: a survey of dermatologists. Int J Dermatol. 2022;10.1111/ijd.16209. doi:10.1111/ijd.16209 
  13. Marson J, Ahmad M, Litchman G, et al. Characteristic distinctions between pre-/post-COVID-19 teledermatology adoptees: a cross-sectional United States-based analysis and the implications for dermatologic healthcare equity. J Drugs Dermatol. 2023;22(1):101-104. doi:10.36849/JDD.7169 
  14. US Department of Health and Human Services. HIPAA Rules for telehealth technology. https://telehealth.hhs. gov/providers/telehealth-policy/hipaa-for-telehealth-technology. Accessed 07 July 2023. 
  15. United States Census Bureau. Computer and Internet Use in the United States: 2018. https://www. census.gov/newsroom/press-releases/2021/computer-internet-use.html. Accessed 10 September 2022. 
  16. Resneck JS Jr, Tierney EP, Kimball AB. Challenges facing academic dermatology: survey data on the faculty workforce. J Am Acad Dermatol. 2006;54(2):211-216. doi: 10.1016/j.jaad.2005.10.013. PMID: 16443049. 

AUTHOR CORRESPONDENCE

Justin W. Marson MD justin.w.marson@gmail.com
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