Practice models and challenges in teledermatology: A study of collective experiences from teledermatologists

April W. Armstrong, Mei W. Kwong, Lynda Ledo, Thomas S Nesbitt, Sandra L. Shewry

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied. Methods: The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California. Results: Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers. Conclusion: Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.

Original languageEnglish (US)
Article numbere28687
JournalPLoS One
Volume6
Issue number12
DOIs
StatePublished - Dec 14 2011

Fingerprint

Reimbursement Mechanisms
Communication
Health
Health Maintenance Organizations
communications technology
Private Practice
Vulnerable Populations
Poverty
communication (human)
poverty
rural areas
Image quality
Motivation
Sustainable development
interviews
Software
History
Interviews
Technology
history

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Practice models and challenges in teledermatology : A study of collective experiences from teledermatologists. / Armstrong, April W.; Kwong, Mei W.; Ledo, Lynda; Nesbitt, Thomas S; Shewry, Sandra L.

In: PLoS One, Vol. 6, No. 12, e28687, 14.12.2011.

Research output: Contribution to journalArticle

Armstrong, April W. ; Kwong, Mei W. ; Ledo, Lynda ; Nesbitt, Thomas S ; Shewry, Sandra L. / Practice models and challenges in teledermatology : A study of collective experiences from teledermatologists. In: PLoS One. 2011 ; Vol. 6, No. 12.
@article{ddb2a2fc92f44a9b91065e33d9584ed6,
title = "Practice models and challenges in teledermatology: A study of collective experiences from teledermatologists",
abstract = "Background: Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied. Methods: The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California. Results: Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76{\%} practiced store-and-forward only, 6{\%} practiced live-interactive only, and 18{\%} practiced both modalities. Only 29{\%} received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47{\%} of teledermatologists served at least one Federally Qualified Health Center. Over 75{\%} of patients seen via teledermatology were at or below 200{\%} federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers. Conclusion: Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.",
author = "Armstrong, {April W.} and Kwong, {Mei W.} and Lynda Ledo and Nesbitt, {Thomas S} and Shewry, {Sandra L.}",
year = "2011",
month = "12",
day = "14",
doi = "10.1371/journal.pone.0028687",
language = "English (US)",
volume = "6",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "12",

}

TY - JOUR

T1 - Practice models and challenges in teledermatology

T2 - A study of collective experiences from teledermatologists

AU - Armstrong, April W.

AU - Kwong, Mei W.

AU - Ledo, Lynda

AU - Nesbitt, Thomas S

AU - Shewry, Sandra L.

PY - 2011/12/14

Y1 - 2011/12/14

N2 - Background: Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied. Methods: The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California. Results: Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers. Conclusion: Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.

AB - Background: Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied. Methods: The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California. Results: Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers. Conclusion: Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.

UR - http://www.scopus.com/inward/record.url?scp=83355172821&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=83355172821&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0028687

DO - 10.1371/journal.pone.0028687

M3 - Article

C2 - 22194887

AN - SCOPUS:83355172821

VL - 6

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 12

M1 - e28687

ER -