DEC 2019 - JAN 20208TELEDERMATOLOGY AND QUALITY: FRIEND OR FOE?Joseph C. Kvedar, MD, Vice President, Connected Health, Partners HealthCare, Professor of Dermatology, Harvard Medical SchoolByDigital health technologies can help bridge the gap between the growing number of patients and the shrinking number of healthcare providers. Yet, for teledermatology, there are a number of challenges and opportunities in the adoption of tools like direct-to-consumer (DTC) websites and mobile apps for treating skin disease. Smartphones, sensors, health trackers and other digital health devices monitor everything from daily step count to blood pressure and sleep patterns. We call this the `consumerization of healthcare,' as individuals have come to expect the same `always on, always available' convenience and service from their healthcare providers as they do for online banking, travel planning and shopping. For dermatologists, these digital health tools can capture images that allow for the accurate diagnosis of skin disorders from the convenience of an individual's home and can help to improve clinical outcomes and patient satisfaction. DTC teledermatology could conceivably reduce costs and achieve equal or better quality of care for patients, without them having to leave their home. However, there are still questions around the diagnostic accuracy of teledermatology, especially in the context of a newly formed doctor-patient relationship. Let's explore this further:Most health care requires authentic relationships.It seems safe to conclude that the possibility of fraud in an online relationship is much higher than in person. Most clinicians feel that forming a relationship with their patients is a core part of providing quality healthcare. Until this authentication challenge is solved, it's hard to imagine many healthcare interactions with new patients being conducted in an online environment. Videoconferencing certainly adds a great deal of value beyond text-based interactions, but video technology does not offer sufficient resolution for most dermatologic diagnoses, necessitating an added layer of complexity (still images). For this reason, most teledermatology systems do not include video interactions.How do we define quality care in this new environment?The idea of allowing patients to upload images of body moles or facial acne for evaluation by providers they have never met gives many of my colleagues great consternation. My colleagues fret that a patient will send them an image of a mole that is benign but ignores a mole that is an incipient melanoma. To me, this seems less onerous than the authentication issue, as patients are capable of managing their own risks when these risks are spelled out. A closely related fear or objection is one of physician liability. In this context, the doctor is not only afraid they will provide substandard care by not doing a complete physical exam but that they may be held liable for that omission. Joseph C. KvedarIn My Opinion
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