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Few derms yet embrace EMR, but Internet a boon for training, teledermatology


National report - While dermatology's visual nature makes it ideal for image-rich electronic applications - from teledermatology to training for residents - few dermatologists have embraced comprehensive systems such as electronic medical records (EMRs), sources say. But they predict this will change with the healthcare industry's growing emphasis on efficiency and accountability.

While no dermatology-specific studies of EMR adoption exist, "The literature says that 15 to 20 percent of all medical practices have some form," says Rosemarie Nelson, a principal with MGMA Health Care Consulting Group. However, she says the proportion of dermatology practices with EMRs likely is smaller because smaller practices automate less frequently.

Information technology's impact on the field of dermatology is "not as big as it will be in the next five to 10 years," says Joseph Kvedar, M.D., vice chairman of dermatology at Harvard Medical School and director of Partners Telemedicine.

However, Dr. Kvedar says that in the next few years, "We will be held more accountable. The big themes these days are safety, quality and transparency. The only way to solve those problems is by having high-quality systems."

EMRs will be mandated by the federal government by 2014, says Daniel M. Siegel, M.D., clinical professor of dermatology at State University of New York, Brooklyn, and an American Academy of Dermatology board member. Designed properly, he says, "EMRs will be very valuable. But right now, the killer application for EMRs in dermatology does not exist."

Training aid

Nevertheless, he says information technology has proven a boon for medical education.

"There's a lot of educational software online," along with image collections and http://Derm101.com/, which offers weekly quizzes, Dr. Siegel says.

Technology has broadened the range of case material available to medical students, says John H. Bocachica, M.D., chief of dermatology and teledermatology at the Alaska Native Medical Center (ANMC) in Anchorage.

"When I was a resident in the 1980s, we would follow the attending around. And he would actually show us patients with certain diseases," he says. But if other diseases weren't available for direct viewing, "We wouldn't see them."

Today, "With the advent of a multiplicity of dermatology Internet sites, I, as an attending, use the Internet heavily in teaching residents," Dr. Bocachica says. "The essence of dermatology is visual" and lends itself to applications including digital imaging, dermoscopy and teledermatology, he says.

"Teledermatology can help with the maldistribution" of dermatologists by delivering their services to underserved regions, Dr. Siegel says.

"The technology for quality teledermatology is here," he says. "The impediment is reimbursement. For the most part, it's difficult to get paid for what one does during teledermatology."

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