International Teledermatology Review.

PURPOSE OF REVIEW: The use of teledermatology has been evolving slowly for the delivery of health care to remote and underserved populations. Improving technology and the recent COVID-19 pandemic have hastened its use internationally. RECENT FINDINGS: Some barriers to the use of teledermatology have fallen considerably in the last year. SUMMARY: Teledermatology use has increased significantly in recent years in both government-sponsored and private health care systems and individual practices. There are no recognized international practice guidelines and variable use within countries. Many barriers remain to increasing the use of teledermatology.

Teledermatology in the United States: An Update in a Dynamic Era.

BACKGROUND: Teledermatology is rapidly advancing in the United States. The last comprehensive survey of U.S. teledermatology programs was conducted in 2011. INTRODUCTION: This article provides an update regarding the state of teledermatology programs in the United States. MATERIALS AND METHODS: Active programs were identified and surveyed from November 2014 to January 2017. Findings regarding practice settings, consult volumes, payment methods, and delivery modalities were compared to those from the 2011 survey. Findings from the Veterans Affairs (VA) were reported as an aggregate. RESULTS: There were 40 active nongovernmental programs, amounting to a 48% increase and 30% discontinuation rate over five years. Academia remained the most common practice setting (50%). Median annual consultation volume was comparable with 263 consultations, but maximum annual consultation volume increased (range: 20-20,000). The most frequent payment method was self-pay (53%). Store-and-forward continued to be the most common delivery modality. In Fiscal Year 2016, the VA System consisted of 62 consultation sites and performed a total of 101,507 consultations. DISCUSSION: The limitations of this study were that consult volume and payment methods were not available from all programs. CONCLUSION: U.S. teledermatology programs have increased in number and annual consultation volume. Academia is the most prevalent practice setting, and self-pay is the dominant accepted payment method. Innovative platforms and the provision of direct-to-patient care are changing the practice of teledermatology.

Practice Guidelines for Teledermatology.

Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.

State of teledermatology programs in the United States.

BACKGROUND: Teledermatology programs in the United States have evolved over the past several decades. No systematic survey of teledermatology programs in the United States is available in peer-reviewed literature. OBJECTIVE: To provide up-to-date information regarding the state of teledermatology programs in the United States. METHODS: Active U.S. teledermatology programs were surveyed in 2011 with regards to practice models, clinical volume, and payment methods. These findings were compared with those from 2003. RESULTS: By January 2012, 37 teledermatology programs were active in the United States. Store-and-forward teledermatology was the most frequent delivery modality offered by 30 (81%) of the programs. The majority of the programs were based at academic institutions (49%), followed by Veterans Administration hospitals (27%), private practice (16%), and health maintenance organizations (HMOs) (8%). The majority of programs (67%) provided services to their home state only, whereas the rest also served additional U.S. states or abroad. The median number of consultations per program was 309 (range, 5-6500) in 2011. The most frequent payer sources were private payers, followed by self-pay, Medicaid, Medicare, and HMOs. Since 2003, with the confirmed discontinuation of 24 previously active programs, the total number of active teledermatology programs in 2011 was 60% of that in 2003. However, the annual consult volume per program nearly doubled for the sustainable programs in 2011. LIMITATIONS: Itemized billing information was not uniformly available from all programs. CONCLUSION: The turnover in teledermatology programs is relatively constant, with an increase in consult volume for sustainable programs. Store-and-forward is the dominant modality of delivery, while hybrid technology model is emerging.

Dermatology and HIV/AIDS in Africa.

Human immunodeficiency virus and the acquired immunodeficiency syndrome (HIV/AIDS) have greatly complicated dermatologic disease and the required care in most regions of Africa. Opportunistic infections, ectoparasites, Kaposi sarcoma, and skin manifestations of systemic infections are exceedingly common in patients with HIV/AIDS. Dermatologists have contributed significantly to our knowledge base about HIV/AIDS and have played an important educational role regarding the clinical manifestations historically. Because of the increased burden of skin disease in Africa due to the HIV/AIDS epidemic we must redouble our efforts to provide dermatology education to care providers in Africa. We review the burden of skin disease in Africa, how it relates to HIV/AIDS and global infectious disease, current educational strategies in Africa to address this need, and suggest potential solutions to move these efforts forward.

Overview of international teledermatology.

Teledermatology is essentially "dermatology at a distance", using one of many communication technologies to expand the reach of a dermatologist to those in need of their specialized knowledge. Most international teledermatology is store-and-forward in nature, a method in which images are stored on a computer and then transmitted electronically to a consulting dermatologist. This system is more convenient and less costly than real-time teledermatology. This review will focus on several of the store-and-forward teledermatology systems being developed and utilized successfully internationally. This discussion of "who" is practicing teledermatology is not comprehensive, but attempts to show some of the breadth of teledermatology practice around the world, including government national health plans, commercial endeavors, and charitable work by individuals and institutions. The goal in many instances is to provide better health outcomes through increased access, efficiency, and/or cost-effectiveness. More studies ultimately need to be conducted to develop a more comprehensive and sustainable model for teledermatology.

Asynchronous teledermatology in an urban primary care practice.

This study evaluated the accuracy, access time, cost, and acceptance by patients and physicians of asynchronous teledermatology referrals in an urban primary care practice. Primary care physicians in a multi-specialty group referred patients for a teledermatology consult. Same-day history and digital images taken by a nurse were electronically sent to a dermatologist who rendered a diagnosis to the physician. Fifty-two patients completed the study. History was adequate for diagnosis in 81% of cases; images were adequate in 75% of cases. Accuracy of the teledermatology diagnosis in cases with adequate images was 97%; accuracy for all cases was 92%. A dermatology visit was recommended in 26% of cases with adequate images, and 42% of all cases. Access time for a teledermatology opinion was 1.9 days versus 52 days for a regular dermatology appointment. Patient and referring physician were highly in favor of teledermatology. Cost evaluations for 20% of patients suggested the cost of a remote consult to be significantly less than the cost of performing an in-person referral. Asynchronous teledermatology may serve as a valuable tool for triage of dermatology referrals and possibly for delivering care to more patients than in urban areas. It can decrease waiting time for a dermatology diagnosis. In an urban multi-specialty clinic-based primary care practice, results suggest the cost of a teledermatology consult is less than that of an in-person service.