Teledermatology

Dermatology TeleOpinion Express Care visits

Teledermatology has been shown to reduce outpatient wait times and increase access while decreasing unnecessary office visits.¹⁻³ In July 2014, the Department of Dermatology launched a teledermatology consult program (eConsult) designed to triage appropriate patients into earlier dermatology appointments, avoid unneeded referrals, and provide informal consultations.

The program has expanded to 18 of Cleveland Clinic’s Express Care Clinics, which are predominantly staffed by nurse practitioners and physician assistants, who evaluate and treat most medical conditions. Store-and-forward teledermatology consultations were placed using secure smartphones or tablets designated for this purpose. Patient photos, along with pertinent clinical documentation in the electronic medical record, were reviewed by a dermatology staff member and resident. Triage outcomes were grouped into 2 categories: The treatment plan outlined by the internal medicine provider was reasonable and a dermatology appointment could be deferred, or a dermatology appointment was required for further evaluation and treatment.

Approximately one quarter (27%) of the consultations required a dermatology appointment. A dermatology appointment was more often recommended for a lesion of concern (53%) versus rash (23%). The eConsult program has decreased unnecessary visits, resulted in greater access to dermatologists, and saved patients time, travel, and expense. At the end of 2017, the eConsult workflow, including consultation request and image upload, was fully integrated into the electronic medical record, allowing providers outside the Express Care Clinics to access the eConsult service.

Teledermatology Triage Outcome (N = 1112)

July 2014 – December 2017

Reason for Consult and Triage Outcome (N = 1112)

July 2014 – December 2017

References
  1. Warshaw EM, Hillman YJ, Greer NL, Hagel EM, MacDonald R, Rutks IR, Wilt TJ. Teledermatology for diagnosis and management of skin conditions: a systematic review. J Am Acad Dermatol. 2011 Apr;64(4):759-772.
  2. Whited JD, Warshaw EM, Kapur K, et al. Clinical course outcomes for store and forward teledermatology versus conventional consultation: a randomized trial. J Telemed Telecare. 2013 Jun;19(4):197-204.
  3. Yim KM, Florek AG, Oh DH, McKoy K, Armstrong AW. Teledermatology in the United States: An update in a dynamic era. Telemed J E Health. 2018 Oct; 24(10): 1-7. Published Online: Jan. 22, 2018 (doi.org/10.1089/tmj.2017.0253).