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PLoS One. 2011;6(12):e28687. doi: 10.1371/journal.pone.0028687. Epub 2011 Dec 14.

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

Author information

1
Department of Dermatology, University of California Davis School of Medicine, Sacramento, California, United States of America. aprilarmstrong@post.harvard.edu

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 (SDĀ±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.

PMID:
22194887
PMCID:
PMC3237480
DOI:
10.1371/journal.pone.0028687
[Indexed for MEDLINE]
Free PMC Article

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