key: cord-1050502-snu86320
authors: Gorrepati, Pavane L.; Smith, Gideon P.
title: Analysis of availability, types, and implementation of teledermatology services during COVID-19
date: 2020-06-10
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.06.022
sha: 766b40560610d42755efa36807dc3ce3870d074a
doc_id: 1050502
cord_uid: snu86320

nan

To the Editor: Given the rapid rise in teledermatology due to the COVID-19 pandemic, we analyzed variations in teledermatology services across the country between academic and private practices. 3 private practices were randomly selected for each state and Washington D.C. from the American Academy of Dermatology (AAD) member list. 1 Additionally, for each state we selected the academic institution with the greatest number of dermatology residents. Only practices with a website were included.

A total of 153 private practices websites and linked-social media accounts were analyzed on April 22. Use of websites had the advantage over calling in that it allowed us to capture a large sample in a single day. 133 practices had an update regarding changes in practices due to COVID-19. Of those, 86.5% indicated that teledermatology was an alternative option for patients in lieu of an in-person appointment. 42.6% of practices indicated use of live video conferencing.

48.7% did not specify what platform they would use to conduct the appointment and that patients would need to contact their office for more information. 1 private practice indicated the use of photographs for the telemedicine visit. 92.2% of private practices did not provide information for patients on their website regarding what conditions would be most appropriate for a telemedicine visit.

Of the 40 academic institutions analyzed almost all mentioned telemedicine as an option for certain specialties on the main webpage, however, only 60% of dermatology departments specifically mentioned teledermatology services. Of those, 50% utilized a video platform. Only 1 academic institution mentioned the use of photographs as their platform for the televisit. 20.8% indicated that both video and photograph or an e-visit was available as an option. 25% did not specify the type of platform they used. Only 16.6% provided specific public instructions regarding how to take photos for virtual care such as taking photos in a well-lit area, focusing the image, or not using the zoom feature. 95.8% of institutions that offered teledermatology did not provide information indicating what conditions would be appropriate for use through teledermatology.

Most academic and private practices offer teledermatology as an alternative in response to COVID-19. Compared to private practices, academic institutions provided less specific information on their websites regarding alternative options. However, it is clear that implementation is highly variable. While many visits may be follow-ups of chronic inflammatory conditions, for accurate diagnoses, high resolution images are necessary and still photographs may have resolution advantage over video alone. Despite that, video, possibly due to reimbursement, was more widely implemented. Still images must be in-focus, have multiple viewpoints, and clearly indicate the lesion or area of concern. Unfortunately, we found little previsit guidance. Our study suggests that, if reimbursement drove selection of video-visits, it should be systematically compared to photography to evaluate outcomes. Secondly, this highlights practice gaps (e.g. image production) where AAD patient-guidelines may be useful.

While our study evaluates early COVID-19 practices, future studies may be valuable to study how teledermatology evolves over time.

Recommendations for Dermatologists. American Academy of Dermatology