Telemedicine tackles access problems

"We have a general interest in providing care models that are more patient-centric, and in using communications technologies to change the process of care," says Joseph Kvedar, M.D., vice chairman of dermatology at Harvard Medical School and director of Partners Telemedicine, which will run the program on behalf of Partners HealthCare, the parent organization of Massachusetts General and Brigham and Women's hospitals.

"We had lots of pressure to do more with what we have in terms of clinic space and staff," he says. "We also had a hunch that patients could take accurate images of themselves using off-the-shelf digital cameras. Additionally, certain skin conditions rank low enough on the risk scale that we were comfortable trying this."

Should the program succeed, it eventually will incorporate care for conditions including plaque psoriasis and childhood eczema. Regardless of the condition, Dr. Kvedar says Partners Telemedicine never intends to keep patients out of doctors' offices if they prefer in-person visits.

Expanding access

But in other areas, sources say teledermatology provides patients' only viable option.

"Once one uncovers pockets of patients that haven't had access to modern dermatologic care, telemedicine is quite compelling," says Karen E. Edison, M.D., medical director of the Missouri Telehealth Network and chairman of dermatology, the University of Missouri Health Care. In existence for more than a decade, the network uses primarily real-time two-way videoconferencing to serve 44 sites in 29 rural Missouri counties. It handles 30 to 40 patients weekly, with dermatology use very frequent, Dr. Edison reports.

When she got involved with the network in 1995, she says, "I saw things I hadn't seen before and stages of disease processes that were quite advanced and hadn't been correctly diagnosed and treated. To this day, as we hook up new sites in underserved portions of our state, we continue to see this kind of pattern."

According to the American Telemedicine Association (ATA), the number of teledermatology networks operating in the United States in 2002 was 62. Approximately two-thirds of these involved live interactive videoconferencing; one third involved store-and-forward digital imaging.

Advantages

Dr. Edison says, "Providing access to those who would not otherwise have access is the major advantage. Additionally, dermatologists are not only in short supply in most areas of the country, they're also maldistributed."

For many rural patients, Dr. Edison says traveling to distant appointments proves impossible.

She explains, "I used to think that if patients had cars, they'd drive to Columbia to see us. But when I started seeing patients in an outreach clinic just 35 miles north of here, I quickly realized that for a variety of reasons, many people cannot easily leave their communities for healthcare."

These reasons include transportation costs and difficulty missing work, Dr. Edison says.