Teledermatology for BC A pilot project sponsored by the Shared Care Committee Dr. Shane Barclay, Dr. Paula Ryan
Telehealth can help meet some of the challenges of remote health care Two types of telehealth 2
Realtime Telehealth Traditional format for telehealth delivery. Pros Most closely mimics a face-to-face visit. Visual and interactive advantages. Cons Significant coordination on either end of consultation Significant human resource demand. 3
Store and Forward Telehealth Pros Timing to suit all those involved in the process. Can maximize technical and human resource utilization. Cons Minor delay in diagnosis and treatment compared to live. Not all specialties are amenable to this format. 4
Dermatology is Ideal for Telehealth Diagnosis is based primarily on visual assessment. Patient history is usually brief and standardized. Can be easily recorded in electronic format. There is a provincial shortage of dermatologists. Excellent for patients who cannot travel to clinics: Too far. Too ill or debilitated (ICU, ER, wound-care patients). 5
Store-and-Forward Teledermatology Early research shows that this service is: Reliable. Time-saving. Cost-saving. Useful to triage dermatology patients. Appreciated by both patients and referring doctors. 6
Consult Derm A Novel Platform for Teledermatology Jaggi Rao, MD, FRCPC Associate Clinical Professor of Medicine Director, Dermatology Residency Training Program Division of Dermatology, University of Alberta Edmonton, Alberta, Canada 7
Referring MD 8 Consult Derm How it works Sees a patient with a dermatological problem. Takes a digital photo(s) of the patient s problem. Logs into Consult Derm. Uploads the images and provides a brief history. Teledermatologist Logs into Consult Derm. Reviews the images and history. Provides: 1) an impression, 2) education, 3) management plan. Referring MD Logs into Consult Derm and reviews the consultation; triage.
Consult Derm Teledermatology Studies The diagnosis and treatment plan made over the system is as effective and comparable to those made in person. Most patients (>80%) actually prefer teledermatology to live dermatology visits. This form of teledermatology is very cost-effective to the system. In Alberta, Consult Derm has reduced the average wait time to see a dermatologist from 104 days to < 3 days. 9
2006: 2007: 2008: 2009: 2010: 2011: Consult Derm TM History Consult Derm conceptualized. Prototype completed. Alberta Health & Wellness and NWT approval. Several validation and efficiency studies performed. Approved by Alberta Privacy Commissioner. Approval in the province of Prince Edward Island Telederm Outreach created (virtual volunteering). Currently: Over 400 referring MDs, >1500 consults per year, used in nursing homes, ER, correctional institutes. 10
Consult Derm Process for Family Physicians The diagnosis and treatment plan made over the system is as effective and comparable to those made in person. Register as a new referring physician by logging into consultderm.com. Scroll down and click on BC.consultDERM. 11
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Consult Derm Process Once registered you will receive an email confirming your registration. 14
Consult Derm Process See patient in office, either on the spot or pre-booked. Take history and enter into EMR. Take pictures. 15
Hints re Camera and Picture Taking Type of camera. AA battery vs rechargeable. When taking pictures: Don t get too close to patient s rash. Don t use high resolution. Usually flash not needed as washes out rash. 16
Consult Derm Process See patient in office, either on the spot or pre booked. Take history and enter into EMR. Take pictures. Download pictures on to the PC. Log into consultderm.com, choose bc.consultderm. 17
Currently within a week or so you will receive an email alert stating you have a consultation waiting on Consult Derm. 28
Consult Derm TM BC: New Features iphone/ipad application 33
Salt Spring Pilot Project By February 14, 2012 we had done 78 telederm referrals, from 5 family doctors. Dr Jackie Cooper (R2- FP) did a cost analysis and patient satisfaction research paper. 35
Salt Spring Pilot Project Patient Satisfaction 95% of patients strongly agreed or agreed that Telederm was more convenient than going off island. 1 patient (5%) was neutral. 100% were comfortable with pictures being taken and sent to a secure web site. 73% of patients were confident the dermatologist could make an accurate diagnosis using telederm. The remaining patients were neutral. 36
Salt Spring Pilot Project Patient Satisfaction Overall 86% were satisfied with the telederm consult. Only one patient was unsatisfied, due to time delay. 86% of patients would rather have a telederm consult than go off island. 37
Salt Spring Pilot Project Economic Impact Average estimate of loss of work income for going off island to a dermatologist was ~ $100/patient (range 0-$350). Travel and incidental costs to patients going off island were ~ $120. (gas, taxi, daycare, parking, etc.). Ferry cost (round trip) to: Victoria $41.40. Vancouver $119.45. 38
Salt Spring Pilot Project Economic Impact Total savings to both patients and MSP by treating 78 patients on Salt Spring Island: ~ $19,600. 39
Summary Consult Derm represents a novel, tried and proven, unique service to improve access and quality of Dermatological care. With improved imaging technology and wide availability of the internet, this service is a logical and immediate solution to the shortage of dermatologists in British Columbia. 40
Thank You BC.ConsultDerm.com Drs. Paula Ryan and Shane Barclay on behalf of Jaggi Rao, MD, FRCPC Associate Clinical Professor of Medicine Director, Dermatology Residency Training Program Division of Dermatology, University of Alberta Edmonton, Alberta, Canada 41
Email Addresses for Telederm Shane Barclay Paula Ryan Jaggi Rao Neil Kitson Wingfield Rehmus Patrick Kenny drsbarclay@gmail.com paularyan@shaw.ca jrao@ualberta.ca nkitson@interchange.ubc.ca wrehmus@gmail.com pgwkenny@shaw.ca 42
For more information Shared Care Committee 115-1665 West Broadway Vancouver, BC V6J 5A4 Tel: 604 736-5551 www.bcma.org