Dec 2019 - Jan 20209Once again, spelling out that a patient is taking accountability for those aspects of his care not addressed in an online interaction seems reasonable to me. I think the liability concerns are overstated.Is the technology up to the task at hand?In the late 1990s, we (and many others) did painstaking clinical studies to empirically test whether a set of digital images is of sufficient quality to be a diagnostic tool in lieu of an in-person exam. There now exists a body of literature that demonstrates this equivalency, with the possible exception of some pigmented lesions. We also carefully examined the feasibility that patients could take their own, clinically accurate, facial images of acne. Are there other examples? Mental health providers routinely care for new patients and conduct follow up visits using video conferencing technology. There are probably a few other examples as well.To provide a quality care experience online without having met the patient in person, I contend that the following criteria would need to be met:1. Limit the interactions to problems that have a diagnostic data set that can be easily and reliably acquired by a consumer/patient.2. Assure that the patient is capable of understanding that the online interaction is problem specific and may carry risks, particularly for the omission of care involving other health problems.3. Assure that the treatment decisions for the specific condition at hand are algorithmic and do not require an authentic relationship (i.e., the problem is transactional or of low emotional value to both provider and patient).There are some things to work out, but there is good to be had by encouraging the thoughtful growth of teledermatology. For example, we need more patient-focused regulation and further study. We should also determine which symptoms are properly suited to online diagnosis versus the need for in-person care. The American Telemedicine Association (ATA) offers an accreditation process for DTC telemedicine. This is an important start, but probably not enough. 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
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