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NOTE

*The views expressed in this chapter are those of the author (JDW) and do not necessarily represent the views of the United States Department of Veterans Affairs or the United States government.

INTRODUCTION

“Around 2001, teleconsultation of a 17 days old child from Louisiana with a red patch on the face was performed with dermatologists at Brooke Army Medical Center (see Figure 9-1). Given the association of hemangiomas on lips with upper respiratory involvement, the dermatologists requested additional information and confirmed some respiratory symptoms that the pediatrician was attributing to potential asthma. The mother drove 8 hours and brought her child to San Antonio, Texas for an in person evaluation the next day where the child was found to have increasing respiratory difficulty. Ear, nose, and throat (ENT) consultation revealed a significant hemangioma in the upper airway. A few days later, the patient had surgery and left the hospital in great condition. We saved a life.”

Figure 9-1.

Child with infantile hemangioma.

Teledermatology is the practice of dermatology using information communication technologies. Teledermatology has experienced an explosive growth in the last several years as health care reform accelerates. As technologies continue to evolve, teledermatology will also evolve as digital skin imaging advances. Teledermatology is well suited for telehealth given the visual nature of the specialty, and it is one of the most mature and well-studied telemedicine applications. Use of teledermatology was first published by Murphy and Bird using a two-way audiovisual microwave circuit at Massachusetts General Hospital to 1,000 patients 2.7 miles away at the Logan International Airport. 1 Teledermatology is now widespread in its use, as documented by an American Telemedicine Association (ATA) Current Active Teledermatology Programs survey 2 (survey is being updated; personal communication with Dr. April Armstrong et al.). Teledermatology is being used by many health care organizations, including federal and state entities (eg, Department of Veterans Affairs [VA], Department of Defense [DoD], Federally Qualified Health Center [FQHC]), academic medical centers, and private/group practices and is being reimbursed by many payors. Although Medicare reimbursement for teledermatology has not changed, state and commercial reimbursement is rapidly evolving to cover teledermatology. Recent health care reforms emphasize value-based care. As virtual care becomes more integrated into mainstream medicine, there is also a shift of focus to a) education of providers and patients, b) quality assessments, and c) resource utilization as part of the value-based care. Finally, direct to patient/consumer teledermatology has had exponential growth, and it will likely increase in demand.

This chapter will review the different modalities used in the practice of teledermatology and the different models of implementation, such as teleconsultation and teletriage. The current status of legislation and its impact on the practice of teledermatology, credentialing and privileging, prescribing, and licensure will be discussed. The challenges facing teledermatology ...

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