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Teledermatology Visits | Tips & Best Practices

Men’s Health recently posted an article entitled “Six Tips for a Productive Telehealth Appointment with a Dermatologist.” While the article gives patients tips for maximizing their teledermatology appointments, what advice do telemedicine experts have for dermatologists when conducting virtual visits with their patients?

I consulted George Han, MD, PhD, director of clinical dermatology and teledermatology, and associate professor of dermatology at Zucker School of Medicine at Hofstra/Northwell.

What are some key ways dermatologists can participate in teledermatology while maintaining patient privacy and security?

HIPAA-secured video visit platforms are readily available and some are free. Some of the HIPAA-secured video platforms use additional compression, so it is important to test out the application before committing to conducting real patient visits with it.

Special caution must be used when obtaining photos of clinical images from patients. While these are immensely helpful in a virtual visit, having the pictures stored in a HIPAA-compliant manner is critical.

Some applications, such as VSee Messenger, have both video capabilities and the ability to conduct a secure chat with photo sending. When these features are on the same application, it makes the process much smoother and easier.

How can dermatologists assuage any patient concerns over the ability to diagnose via teledermatology?

Rates of diagnostic accuracy were found in multiple studies to be similar to in-person care, and teledermatology has been in use for more than 20 years.

Setting up the virtual visit for success is important. Insist on static, high-resolution images under good lighting, and ask that the patient be stationary with access to wi-fi during the visit itself.

What are some tips for helping patients navigate the teledermatology process, such as lighting, type of device, photo quality, etc.?

When taking photos of the rash or lesion, patients should make sure to use the higher-resolution, backwards-facing camera on their device. In most cases, the camera on modern smartphones has adequate resolution, but they are very sensitive to lighting and have a tendency to capture out-of-focus images if not set up properly.

Try to have patients take pictures of both the area of the body they’re trying to capture and a detailed photo of the lesion or rash being evaluated. Bright, natural lighting is best. Patients should be situated in a private area with appropriate clothing to show the area of the body affected, if necessary. When asking the patient to show a part of their body on the video, have them first turn the camera to the rear-facing one. Most telemedicine apps have this feature, and this allows you to both have access to the higher resolution camera while allowing the patient to more easily see what they’re showing you.

How do you communicate with your patients in advance to ensure a productive teledermatology appointment? 

Have a tip sheet available for download with instructions for interfacing with the application, including any necessary downloads or registration steps. Having all onboarding paperwork done prior to the visit is helpful to ensure a timely start to the appointment. Requiring the patient complete a virtual attestation that he or she is located in a state where you hold an active medical license helps make sure you are able to bill for the visit and legally provide medical care to the patient.

Do you request photos in advance? If so, how do you receive these images in a secure manner?

Photos prior to the visit are the single most important and helpful thing in ensuring a successful teledermatology visit. Secure, HIPAA-compliant email may be used to receive images. In addition, several patient portals, such as EPIC MyChart, allow patients to upload images. Some telemedicine platforms allow for both secure photo upload and video visits, such as VSee Messenger.

What are some insurance considerations dermatologists should keep in mind when offering teledermatology?

The patient must be located in a state where the provider holds an active medical license. The two key portions of the telehealth attestation that your note must have are that the visit was conducted via a live interactive audio/video telehealth platform and that the patient was located in whichever state you are licensed to practice medicine.

The new MDM billing criteria help ensure billing levels for telemedicine visits are not reduced by a lack of a detailed physical exam. Certain insurance plans have rolled back the telemedicine reimbursements to “facility fee” levels which are 20%+ lower than in-person visits. It is important to check with your carriers about their policies so you can determine what makes sense for your practice in your specific area. Some companies are still reimbursing at higher rates for telephone calls, so it’s important to know this in advance.

What additional tips do you have for dermatologists in implementing teledermatology and offering productive teledermatology visits?

There are many ways that telemedicine can be integrated into your practice that help supplement your in-person visits without reducing your ability to provide necessary procedures or clinical care. Telemedicine can be a way to recruit new patients to your practice, and these patients may eventually choose to have cosmetic procedures at your practice and refer their friends. Having a few spots for telemedicine visits during “catch-up” or documentation time can help make those hours of the week more productive. Patients with an urgent question or requesting refills may be directed to a telehealth encounter rather than just taking up your time with a phone call.

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