May 14, 2020
How is dermatology handling this
change in practice toward telehealth? Guest host Dr. Candrice Heath
talks with Dr. George Han about
how dermatologists can adapt their
clinical practice to conduct quality teledermatology visits with
their patients. “Last
year ... I think overall in the health system we probably had about
2,000-3,000 telehealth visits ... by the end of March [this year],
I think the numbers I saw [were] around 30,000, so it’s absolutely
just kind of been a huge change in the way we practice medicine,”
Dr. Han explained. They discuss potential use cases for
teledermatology during the current health crisis and beyond as well
as how to address technological barriers to care.
We also bring you the latest in dermatology news and
1. Novel inflammatory
syndrome in children possibly linked to COVID-19
2. Case reports
illustrate heterogeneity of skin manifestations in COVID
3. COVID-19 Dermatology
Things you will learn in this episode:
- Despite recent HIPAA relaxations,
dermatologists still should be aware of privacy and security issues
when conducting telehealth visits with patients.
- Existing resources -- such as noninvasive tests
that can be self-administered by patients -- may be useful for
concerning lesions that are difficult to diagnose during video
visits. “There’s this genomic test for melanoma. ... I hadn’t used
it very much before the COVID pandemic because we could biopsy
patients in the office. ... But now that the whole paradigm has
changed, I’ve actually used it more than I ever did before,” Dr.
- Common conditions such as psoriasis, acne, and
eczema are relatively easy to triage via telemedicine. “We’re going
to have to do a lot more experimentation, certainly, if there’s a
lesion that’s scaly and erythematous. ... But I think as long as
you’re up front with the patients, they understand it, too,” Dr.
most cases, total-body skin examinations and evaluation of
pigmented or potentially cancerous lesions still warrant an
- Biologics often can be started in patients with
psoriasis or atopic dermatitis without first seeing them in person.
“If it’s a pretty clear case of psoriasis, I would say that your
treatment options are not limited by the fact that we’re handling
over telemedicine, and I think that’s really nice for our patients.
There are a number of treatments out there that you don’t need
laboratory screening for, so those are helpful to have on hand,”
Dr. Han said.
older patients who may not have the necessary technology skills or
devices to participate in video consultations, the Centers for
Medicare & Medicaid Services recently issued a guidance that
telephone visits will now be paid at the level of an established
visit (levels 2–4). “The recognition is there that we’re still
doing important work for our patients and you don’t necessarily
need that video signal to be able to do this, and we certainly
don’t want to create any artificial barriers to access to care,”
Dr. Han said.
to COVID-19, telehealth services use was low because patients did
not think of it as a legitimate option, but the marketplace will
demand these services moving forward now that they are seeing the
benefits. “I think it’s important as we go ahead in the next phase
... we use the lessons we’ve learned during this pandemic of just
large numbers of people utilizing teledermatology services to help
map out what makes sense for our specialty ... as well as technical
requirements that we should be asking of our vendors providing
these services,” Dr. Han advised.
- Beyond the parameters of the COVID-19 pandemic,
teledermatology also provides access to care for patients in parts
of the country with limited access to dermatologists, such as in
- Dermatologists can use telehealth services for
short hands-off visits, such as to counsel patients, check in
before titrating doses, or follow-up after a cosmetic procedure.
“Those are situations where you actually might improve your show
rate by offering telemedicine services,” Dr. Han noted.
A tip sheet is available
online that provides
information to help dermatologists adopt telehealth in their
practice. It describes what you need, how to select a software
platform, and how to monitor workflow.
- Patients should be asked to provide
high-quality photographs before the visit via a HIPAA-secured chat
or email. “We always recommend that you get a HIPAA-secured email
server account if you can if you’re asking for patients to send in
photos, because what happens is that once they send those photos to
you, you are responsible for the safety and security of that
photo,” Dr. Han explains.
expectations for patients up front and be realistic about what you
think is reasonable for implementing telehealth services in your
practice. “If you’re not comfortable seeing concerning lesions,
suspicious moles, those things, you should make it very clear to
your schedulers that patients should be told that if it is one of
those problems, they cannot be seen by this methodology,” Dr. Han
Andrews; Candrice R.
Heath, MD (Temple University Hospital, Philadelphia)
Guest: George Z. Han,
MD, PhD (Icahn School of Medicine, New York)
Dr. Heath and Dr. Han report no conflicts of interest.
Show notes by:
Alicia Sonners, Melissa Sears
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