Store-And-Forward Teledermatology: Scale Your Dermatology Practice
This article covers the advantages of store-and-forward technology, the disadvantages of live video conferencing, why store-and-forward is the technology of choice in dermatology and how you can scale your practice with this technology.
Author: Jon Friis, founder and CEO of Miiskin.
The virtual delivery of healthcare services is a reality in most developed countries. According to McKinsey1, early in the COVID-19 pandemic, telehealth surged as a way to deliver healthcare safely. In April 2020, the use of telemedicine was 78 times higher than in February 2020.
This change, driven out of necessity, was enabled by an increased willingness from consumers and providers to use telehealth services, the regulatory changes that allowed this transition, and the changes in the reimbursement model that took place after the COVID-19 pandemic.
The pandemic has given the healthcare system a way to reinvent itself and change its business model to a hybrid virtual/face-to-face model. The goal is to increase access to specialized healthcare, improve treatment outcomes, and optimize resources.
The two technologies commonly used when delivering virtual care are synchronous and asynchronous telehealth solutions.
Although synchronous telemedicine, commonly known as real-time telemedicine, found widespread adoption in dermatology as an alternative to face-to-face conversations during the pandemic, there are many advantages to asynchronous telemedicine, which is also why telemedicine research in dermatology has predominantly had a focus on the asynchronous mode.
What Is Store-And-Forward Telemedicine in Dermatology?
Asynchronous or store-and-forward telehealth relies on patients sharing information outside of real-time consultations – preferably through a HIPAA-compliant platform in the United States. The provider then reviews this information without interacting with the patient in real-time.
In dermatology, the information shared typically includes:
- Demographic data
- Medical history
- High-quality images
Typically, patients use a smartphone app to gather and send information. The information collected is then accessible to providers via a web portal.
Store-and-forward teledermatology solutions offer more privacy to patients and increased flexibility to both patients and clinicians2.
Benefits of Store-And-Forward Teledermatology
According to research, from a diagnostic point of view, SAF technology is at least on par with high-quality live video conferencing;3 however, to obtain high-quality video images both parties need to have an extremely stable internet connection, which is highly unlikely.
On the other hand, store-and-forward solutions have very few technical requirements and providers and patients do not need to be available at the same time which is extremely convenient.
The benefits of store-and-forward telehealth in dermatology are many; besides, research shows that high-quality images in virtual consultations provide high patient satisfaction.
That is why a series of teledermatology companies have popped up in recent years.
The most important benefits of store-and-forward telemedicine in dermatology:
- More convenient
- Reduced waiting times
- Effective utilization of resources
- Delivery of efficient care
- Second opinions can be easily obtained
More convenience for providers and patients
Patients and dermatological providers do not have to be available at the same time. Patients can enter their data and send photos of their skin condition whenever they have time; providers can access this information when it fits into their busy schedule. If there are no real-time appointments, the overall efficiency for many types of visits is higher.
Reduced patient waiting times
Access to specialist care, such as dermatologists, is typically associated with longer wait times. However, providers can use a store-and-forward teledermatology platform as an online patient triage tool to evaluate each consultation request and prioritize those patients who need urgent care based on their visual assessment of a high-quality image of the problem and the responses to carefully designed questions that accompany the image.
Effective utilization of resources
Typically, a dermatologist can take up to five face-to-face or virtual consultations in real-time in an hour. However, with a store-and-forward solution, they may be able to review up to 20 cases5 in the same period.
Delivery of efficient care
Store-and-forward telehealth allows dermatologists to compare their patients’ high-quality longitudinal photos over time and side-by-side to make a more informed decision about their treatment than would be available from a video stream alone. It also accounts for better documentation and storage of the patient’s health records necessary for teledermatology reimbursement purposes.
Second opinions can be easily obtained
Store-and-forward (asynchronous) teledermatology allows non-specialist providers to easily consult colleagues and get a second opinion on a patient’s case. By sharing the patient’s data and high-quality images, providers can consult specialists such as a dermatologist, even if they are located in a different geographical area.
Catering to the digital patient
Dermatological providers who have not embraced teledermatology, risk being left behind. A Cisco global survey revealed that 74% of patients prefer easy access to healthcare services rather than going in person6.
With Miiskin PRO, dermatologists can offer the complimentary use of the Miiskin app to their patients and then access the high-quality photo diaries of patients’ moles and wider skin areas.
High-quality photos taken over time can improve medical decision-making during consultations. A photo diary of skin health fills in the gaps to supplement what the clinician sees and is told in the physical or virtual appointment. Store-and-forward telemedicine solutions can alleviate issues with video quality that make observing conditions more challenging.
Comparison of the Requirements Between Store-And-Forward and Live Video Conferencing
The table displays the different requirements that store-and-forward and live video conferencing have, which affect their suitability for healthcare delivery in dermatology6.
|Requirements||Store-and-forward||Live video conferencing|
|Availability of internet connection||Can be prepared without the internet (ie, photos, history) and uploaded or downloaded at any time.||Simultaneous and continuous internet connection is required for both parties.|
|Speed of internet connection||Internet speed is unimportant.||Slow internet speed may lessen diagnostic accuracy.|
|Appointment||No appointment is necessary as evaluation is asynchronous.||Appointment required for synchronous evaluation.|
|Webcam or mobile phone camera||Useful but not required. Pictures may be on file or taken with any device.||A webcam or mobile phone camera is required for both parties for the entire session.|
|Personal identification||Anonymous access is possible.||Identification is required for a face-to-face consultation7.|
The table above outlays the technological advantages of SAF, which is also why it is the preferred choice by providers and patients.
Disadvantages of Live Video Conferencing (LVC) In Dermatology
- Compliance and liability issues
- Incorrect diagnostic outcomes
- Short delays create a backlog of patients
- Privacy concerns
Compliance and liability issues
Live video conference is not compliant since it doesn’t allow providers to document the medical visit as opposed to SAF technology, where it is possible to document the patient’s condition and the treatment plan.
Incorrect diagnostic outcomes
To provide an accurate diagnosis, the internet connection needs to be very stable to obtain high-quality video images, which is not possible in most cases. Low-quality video can be the cause of a wrong diagnosis.
Short delays create a backlog of patients
To remain on schedule, patients and providers need to be connected to the call at exactly the same time, a delay of just a couple of minutes per patient will delay the entire schedule creating a backlog.
Patients may feel uncomfortable displaying private body parts in front of a live camera. The skin lesion could also be located in an area that is hard to view in front of a computer or smartphone.
Growing Your Dermatology Practice With Store-and-forward Telehealth
Miiskin PRO is a store-and-forward teledermatology platform that is affordable and easy to use. It consists of a smartphone app for patients and a web portal for providers.
- It helps providers prioritize care delivery by enabling triage, which involves reviewing their patients’ smartphone images and clinical questionnaire responses to determine the patients who need immediate assistance.
- It saves time by enabling prescription refill visits to take place virtually and asynchronously. Patients use the Miiskin app to fill in the clinical questionnaire and upload photos of their skin condition. Providers use a web portal to review this information and approve the prescription refill if they deem it necessary.
- Allows providers to be more efficient by helping them to evaluate more patient cases in less time. It is possible for a dermatologist to take up to five face-to-face or virtual consultations within an hour. However, with a store-and-forward solution, this number may be able to increase to up to 20 cases10 in the same amount of time.
Twin Cities Dermatology Center implements Miiskin PRO, a store-and-forward teledermatolgy platform
Besides getting all the platform’s functionality, she attracts new patients by allowing them to request a consultation via the Miiskin app.
Patients need to download the Miiskin app, link to the clinic with a customized office code, enter their details, and upload photos of their skin condition. She can then evaluate the request, and if she deems it necessary, the patient can skip the waiting time and schedule a consultation immediately.
With Miiskin PRO, her patients can also request a prescription refill virtually, without having an in-person or video consultation. This saves her time, gives her a more flexible schedule, and allows her to attend to more patients throughout the day.
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