Teledermatology: Issues in remote diagnosis and management of cutaneous disease

Abstract

Since the 1970s, long distance communication technology has become highly developed. Along with the communications revolution has been a parallel in the use of the technology to deliver health care. Early work in rural Western states, Canada, and Europe laid the groundwork for the rapid expansion of telemedicine programs throughout the world in the 1990s. Dermatology has played an important role in many programs because of the visual nature of the field. Pilot programs in both interactive video and store-and-forward have demonstrated effectiveness in diagnosing cutaneous disease and skin tumors. Equally important to the delivery of teledermatologic care is the ability of dermatologists to make management recommendations beyond the training of most primary care physicians. Telemedicine technology is continuing to advance with improvements in cameras, lenses, and monitors and increased access to higher-end communications options such as integrated services digital network and digital subscriber lines. Further advances over the next decade in both hardware and software will likely further enhance the ability to diagnose cutaneous disease at a distance. As with any clinical practice, understanding the legal ramifications is very important before entering into a field. Licensure issues continue to be a barrier for teleconsultations across state lines. Consent for teleconsultations, credentialing where applicable, and liability and liability insurance issues are very important to address before starting a teleconsultation service. The technology of telemedicine, although decreasing in cost, still has a high price tag. To date there are few good data to justify teleconsultations on a cost savings basis. Intangible factors such as distance traveled for a live consultation and time away from work become important in the overall cost-effectiveness analysis but have little direct financial benefit for a practicing physician. Improvements in technology and increased accessibility often mean lower costs, which may eventually favor teleconsultations. Despite the cost and difficulties associated with teledermatology, it still presents itself as a very viable form of health care for rural or underserved populations and may serve to reach communities where dermatologists are not readily available. (Curr Probl Dermatol 2002;14:1-40.)