Skin conditions are one of the most common reasons for patients to present to their family doctor, with more than 200.000 new cases diagnosed per year in Germany alone. A global shortage of dermatologists and an aging population means referrals into secondary care for long term skin conditions, as well as cancer, and the associated waiting times, continue to increase.
Reducing the number of referrals to secondary care would enable faster treatment and result in improved clinical outcomes, however this approach relies upon increasing community-based dermatology. Teledermatology is a key enabler in adopting this model of care, and yet despite the clear advantages, it still has a limited role in practice.
There are a number of reasons why this is the case:
Doctors are already at full capacity dealing with existing patient caseloads, and don’t have the time to explore ways of changing the way they work. Effective teledermatology requires adjustments to the care pathway; it’s not simply a case of working in the same way with additional equipment.
Some doctors, particularly those who have been practicing for some time, are non-technical, unused to adopting new technologies, and don’t always see the benefits it can bring to them and their patients. As well as individual practitioners, the wider stakeholder group must also recognize the value of introducing teledermatology for it to be successful.
Funding opportunities and compensation structures at a central level will accelerate the adoption of specific technologies in healthcare. As well as financial investment, embedding new technology into care delivery requires staff training and adapting pathways, all of which involve personnel time and ongoing support from technology partners.
As with all digital technology, effective teledermatology relies upon sufficiently fast connectivity, whether broadband or cellular, as well as appropriate hardware.
Digital dermoscopy provides excellent imaging, and reduces the need for face to face appointments, enabling more patients to be seen more quickly. Consultants are no longer tied to onsite consultations, increasing flexibility of care delivery and making it much easier to support patients in rural locations.
Overcoming the short-term challenges can lead to substantial long-term gains. The effective introduction of digital dermoscopic imaging can seamlessly connect community care with dermatology specialists, improving patient flow. There are a number of delivery models, but all rely upon dermatologists being able to view high quality imagery remotely, and therefore being able to make a fast decision on whether it’s necessary for them to see the patient. Community-based practitioners, equipped with digital dermatoscopes and supported by effective training, can not only improve their own diagnostic skills, but easily confer with specialists when required, rather than automatically referring patients. This reduces the number of unnecessary appointments, thereby ultimately reducing waiting times, and enabling early intervention in complex cases.
Using a digital, cloud-based system means image delivery is rapid, and collaborative/interdisciplinary case conferencing between medical groups and nurses is faster and easier.
Digital solutions support effective clinical decision making across a wide range of dermatological practice, such as classic video dermatoscopy; documenting patient history; pre- and post-operative documentation; after care and follow up. Teledermatology also supports clinical decision making related to a wide range of medical conditions, such as skin cancer, eczema, psoriasis and wound care.
For example, in nursing homes images relating to wound management and screening can be viewed remotely both by GPs and dermatologists to inform next steps in treatment, avoiding the need for either visits to the home, or from the home to the clinic. This, of course, reduces travel time for clinicians, but also minimizes disruption for residents, a high proportion of which have a dementia diagnosis and therefore may find changes of environment distressing. This approach also minimizes the time spent by care home staff travelling with residents to appointments and consultations. Local nursing teams can also operate screening and wound management follow-up remotely, increasing caseload capacity, reducing risks of cross-infection and enabling suspicious lesions to be promptly referred for specialist attention.
The benefits to day-to-day practice and patient outcomes of increasing community-based care enabled by technology are clear. It can significantly close the gap between demand and capacity, realize financial efficiencies with early intervention reducing the need for more complex care, and improving the patient experience.
Younger patients have grown up in a digital world, and not only accept, but expect, healthcare to become more digital too. Healthcare practitioners need to start increasing their use of technology, embedding it into everyday practice in preparation for a more digital future.
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