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Limitations & Future Directions of Telemedicine

Article

Telemedicine is a critical tool during COVID-19, but there are limitations.

This is part 2 of a 2-part series.

Part 1: Tele-Dermatology During COVID-19

The difficulty of getting high-quality images or videos to accurately assess patients is a universal limitation experienced during tele-dermatology visits. Newer, more savvy iPhones provide clearer images than my older, outdated work phone does. While its particularly useful when you have an ongoing relationship with a patient, it is difficult to meet a patient for the first time through a smartphone.

In particular, dermatologists like myself have found that while it is useful as an adjunct option or helpful to check in on patients, it is not a substitute for a face-to-face appointment. Routine skin cancer screenings and full body examinations have been postponed for in-person visits as they are difficult to do virtually. I’ve also found it helpful for patients when they have someone hold their phone to show me a particular lesion or rash. It is also essential to include lesions that are suspicious for skin cancer during a tele-dermatology consult and refer for an in-person visit as soon as possible.

Future Directions

Given the high contagion and widespread incidence of COVID-19 throughout the US and globally, telemedicine provides a venue to treat patients remotely without putting their health (or yours) at risk. It is particularly useful for elderly patients, immunocompromised patients and those with non-urgent or routine issues. Undoubtedly, it also promotes the social distancing guidelines set forth by the CDC and state governing bodies.

While it may not seem straightforward, the implementation of tele-dermatology in practices is growing and evolving. The AAD has recommended guidance for CMS and private insurance companies. In addition, dermatologists may also use new methods for providing telemedicine services without fear of violating HIPAA during this time of crisis. A list of recommended platforms has been compiled by the AAD and can often be used hand-in-hand with your EMR. As telemedicine becomes more widespread in dermatology and aesthetics, I'm confident that further improvements into its technology will follow.

References:

Viola, Kate V. et al. Effective use of teledermatology: Defining expectations and limitations as we move forward. Journal of the American Academy of Dermatology. Volume 66, Issue 1, 157

Senel E. History of teledermatology: a technique of the future in dermatology. Skinmed. 2010 May-Jun; 8(3):167-70.

Pak HS. Teledermatology and teledermatopathology. Semin Cutan Med Surg. 2002 Sep; 21(3):179-89.

Lee JJ, English JC. Teledermatology: A Review and Update. Am J Clin Dermatol. 2018;19(2):253-260.

Whited JD. Teledermatology. Med Clin North Am. 2015;99(6):1365-79, xiv.

Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatol Pract Concept. 2018;8(3):214-223.

Campagna M, Naka F, Lu J. Teledermatology: An updated overview of clinical applications and reimbursement policies. Int J Womens Dermatol. 2017;3(3):176-179.

AAD Coronavirus Resources & COVID-19 Task force

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