Q&A: Store-and-forward Model Could Be Future of Teledermatology

Telemedicine has evolved dramatically in the past few years and its growth was exponentially accelerated by the COVID-19 pandemic.

In dermatology, telemedicine has benefits for patients and providers alike. Healio spoke to Jon Friis, founder and CEO of Miiskin, a teledermatology platform, about how teledermatology has evolved and where it is going in the future.

Q: How has teledermatology evolved in the past decade and how did the COVID-19 pandemic affect its growth?

Friis: The different areas of teledermatology have evolved a lot during recent years due to the last decade’s advancements in technology and the adoption of smartphones. Especially impactful was the recent natural developments in the reimbursement system and the passing and adoption of the telehealth parity laws in many states across the U.S. giving the patients the rights to receive telemedicine when suitable and the private payers the obligation to cover for the telehealth visit at the same level as a physical consultation. This is a huge win for teledermatology, and it comes with so many efficiency advantages. The reimbursement and coverage infrastructure is finally maturing and ensuring that providers can secure profitable tele-visits as a natural part of the daily operations and meeting the demand from the growing population of digital patients.

I think one of the most important learnings during COVID-19 was that for dermatologists, live videoconferencing didn’t really make sense. It uses the same amount of time as a face-to-face visit but doesn’t have the same quality or efficiency. The future of teledermatology is store-and-forward solutions, direct-to-patients and supported with high quality images and clinical questionnaires answered by the patients prior to seeing the doctor.

Q: What are the main benefits of teledermatology for patients and for providers?

Friis: For the patients, store-and-forward teledermatology enables them to initiate care access conveniently from the comfort of their own home, and if something is found to be critical, they will be prioritized. For example, if the concern is skin cancer or melanoma, the care process can be initiated without driving, scheduling and taking time off from work, which makes it easy to fit into a busy life.

For the clinics and providers, they can now finally meet the rising demand from the digital patients and at the same increase efficiency and throughput. They have the ability to serve digital patients during no-shows and cancellations, while turning telehealth visits into profitable digital consultations, especially for less concerning skin conditions (such as mild to moderate acne, rashes and eczema), medication refills and triage for moles and lesions. Some dermatologists estimate that with time, 30% to 50% of consultations can be handled through digital store-and-forward platforms, which I believe will play a central role in the fight against staff burnouts and staff shortage due to the provider capacity increase that can be used for balancing the workload better or serving more patients.

Q: What are some drawbacks of teledermatology for both patients and providers?

Friis: Live video conferencing comes with a range of complexities such as lower quality documentation and the same or more time used per patient. The synchronous nature of the visits is another complexity — the patient can use a lot of time setting up the video call and be slightly delayed, which will leave the provider idle.

Asynchronous store-and-forward comes with advantages compared with live video conferencing. The patient and the dermatologist do not need to be present at the same time. There is a high quality of digital images and documentation, and the patient can prepare the documentation of the skin condition prior to meeting the doctor. Additionally, there’s a fast feedback loop to the patient and the doctor has the ability to prioritize necessary physical consultations if needed.

It’s critical to say that only a portion of telehealth requests — 30% to 50% — can be concluded via telemedicine directly and the rest can then be prioritized into a physical consultation depending on the skin concern that has now been reviewed. This leaves the clinics with an efficiently prepared physical consultation with the right type of provider.

Q: When should patients opt for teledermatology appointments and when should they be seen in person?

Friis: In general, teledermatology works most efficiently for less severe skin conditions such as mild to moderate acne, some rashes and burns, medication refills, eczema, etc, but also to triage skin lesions and moles. It will always be the dermatologist or provider that selects which patient requests are suitable for telemedicine — not the patient.

Q: How have dermatologists adapted to teledermatology practices in recent years?

Friis: It has been a slow start especially since the reimbursement — private payer coverage — needed to mature in order to create an infrastructure where providers could claim coverage that matched the face-to-face consultations. This has now happened with the passing of the parity laws. I believe there are around 30 states that have approved some sort of parity law and the rest will most likely follow over the next couple of years.

Q: What are the main hurdles for clinicians in using teledermatology technologies?

Friis: Technology and solutions are easy and secure to set up and at a very reasonable cost. One of the main hurdles is knowledge and education around the difference between live video conferencing and store-and-forward teledermatology. Another hurdle is creating the awareness that the private payer coverage exists under the parity laws — and of course which CPT code to use for this.

Q: How is teledermatology able to improve care?

Friis: It’s a huge improvement for the patients. They can start the care delivery process fast and conveniently from home. Many states have months of waiting in order to get access to a dermatologist. We have had patients on our platform that have been diagnosed with skin cancer by a dermatologist in a matter of days instead of the traditional months in the waiting line. Others have received acne medication prescriptions within 24 hours due to the patient-reported images and documentation, which improves care delivery time and efficiency immensely.

Q: Where do you see teledermatology going in the next decade?

Friis: Especially moving away from live video conferencing solutions going toward store-and-forward solutions, and I strongly believe that a personal skin imaging app technology is the enabler to move the industry toward store-and-forward teledermatology. Taking good images at home by the patients is not trivial and needs the additional support from artificial intelligence, machine learning and camera augmentation. With the reimbursement in place and the app tools available, we should see this shift taking off now. No need to see a dermatologist in-person for minor skin concerns.

Q: How can clinicians help advance telehealth initiatives?

Friis: They can educate themselves about the parity laws and store-and-forward teledermatology solutions. We have a lot of articles and white papers on these topics at miiskin.com, and they are always welcome to reach out if they have questions about reimbursement and CPT codes or if they need to understand how the technology can facilitate patient visits online.