tell us about telehealth
TRANSCRIPT
ConsultDerm BC Teledermatology Initiative
Prepared by Dr. Shane Barclay, Sarah Stephanson, and
Dr. Wingfield Rehmus
Teledermatology Initiative
The Shared Care Teledermatology initiative makes dermatological consults available for family physicians in urban, remote, and isolated communities in BC through easy to use digital technology and secure, confidential Internet access through ConsultDerm BC
The Shared Care Committee, a joint committee of Doctors of BC and the Ministry of Health works to improve health outcomes and the patient journey through the health care system
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Why We Need Teledermatology?
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Front page - Vancouver Sun - November 2013 :
BC suffers shortage of dermatologists
BC has estimated shortage of 24 dermatologists Only dermatologist in Northern Health Authority has retired Wait times for consults have doubled over previous years * * * * * * * *
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Teledermatology Options
Live Teleconsultation Advantages
Communication with patient Reimbursement for MD
Disadvantages Costly equipment Difficult scheduling
Store and Forward Advantages
Better image quality Empowering and educational for GP’s Supports relationship between GP and
patient
Disadvantages Unable to make incidental diagnoses
http://www.ajc.com/news/news/local/state-leads-the-way-in-telemedicine/nQPqk/
http://www.aad.org
Teledermatology Studies Found The diagnosis and treatment plan made over the system is as effective
and comparable to those made in person (90-95% accurate) Many patients prefer teledermatology to live dermatology visits Teledermatology is generally considered cost-effective
Decreased wait times leading to better outcomes Fewer in-person visits
Less time off from work
In Alberta, ConsultDerm has reduced the average wait time to see a dermatologist from 104 days to < 3 days
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What is ConsultDerm BC? Web based program, free to patients and doctors, that allows doctors
in BC to obtain a dermatological consultation in a timely fashion. Uses ‘store and forward’ technology where the referring doctor takes
pictures of dermatological cases, logs into the ConsultDerm BC site then downloads the patient history and pictures
GOAL: Provide consult within 48 hours
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Utilizes a program developed by Dr. Jaggi Rao from the University of Alberta. It is a ‘not for profit’ program.
Dermatologists are reimbursed for their participation in the project on a per consult basis.
Now being used in Alberta, BC, NWT and PEI.
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What is ConsultDerm BC? cont’d
More About ConsultDerm BC
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All dermatology consults tracked and answered No consult is lost or delayed Past consults are readily available All physicians and nurse practitioners in BC have access No specialized software needed System interface is easy to use The database is secure and confidential
How Does it Work?
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Register with ConsultDerm – takes 5 minutes Must be a BC College registered physician with an MSP number (family
physician or specialist) Using PC, Mac, iPhone/adroid, tablet etc, log into:
https://bc.consultderm.com/Login.aspx
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See patient in office, either ‘on the spot’ or pre-booked
Obtain consent – this can be a signed consent, or a verbal consent charted in your notes
Take history and pictures Log into ConsultDerm Submit the consult (includes pictures)
Request a Consult Through ConsultDerm
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How it Works Once your referral is sent - an email alert goes to the Teledermatologist who then:
Logs into ConsultDerm Reviews the images and history Provides:
1. an impression; 2. a ‘note’ (educational component); 3. recommendation/management plan.
Once the Teledermatologist has completed the consult, an email alert goes to the referring doctor who then:
logs into ConsultDerm retrieves the consult reviews results with the patient
Review Your Consult Results
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This information is the teledermatologist’s consult The information from here down is the information you provided for the consult
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Just like any other consult letter, it can be printed off and scanned into the patient’s chart
Print Your Consult Results
Review With Your Patient
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A copy of the consult letter, along with any patient handouts provided by the teledermatologist, may be given to your patient
Teledermatology in BC
Study by Drs Barclay and Cooper 95% strongly agreed or agreed that telederm was more
convenient than going off-island (1 pt “neutral”) 100% comfortable with photographs being taken and sent to a
secure website 73% confident that dermatologist could make accurate
diagnosis (Other patients “neutral”) 86% satisfied (1 unsatisfied due to time delay) 86% prefer telederm to off-island face-to-face consultation
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2 prototype sites in BC: Salt Spring Island Central Okanagan, through a partnership with the Central Okanagan Division of Family Practice
Teledermatology Impact - Quantitative
Currently used by more than 450 BC family physicians and 9 Dermatologists:
Dr Patrick Kenny
Dr Carmel Anderson
Dr Jaggi Rao
Dr Alistair McLeod
Dr Wingfield Rehmus (pediatrics)
More than 900 consults completed to date
Dr Vincent Ho
Dr Gabriele Weichert
Dr Kevin Peter
Dr Donald Jenkins
Teledermatology Impact - Qualitative
“Rapid access to online Dermatology resulted in me being able to manage my patients and reduce patient anxiety regarding assessment and treatment.”
“This has been an excellent learning tool for me. I feel like I have a good understanding of dermatology after working in family practice for many years, but there are patient conditions that still stump me. I can see this being very helpful for new doctors as well.”
It only takes me about 5 minutes, using my iPhone, to take the picture and send it in.”
Teledermatology Impact - Qualitative “I had this patient with atypical eczema and was comfortable with the
assessment. But the patient and parent wanted a consult to the dermatologist. I sent the picture to ConsultDerm and had a response back the next day confirming my initial finding. The new 14076 patient conference fee code enabled me to phone the patient with results of which reduced their anxiety and avoided a follow-up visit.”
“I had this 14 year old patient with a keloid scar and was going to provide an injection in my office. Before the therapy I sent Dr Anderson a picture who confirmed the issue and recommended a dilutions schedule. This was hugely helpful as the recommended starting dose was much lower than I had expected. The first treatment worked so well, I didn’t see the patient again. Without access to online dermatology, this kid would have waited 6-9 months.”
Teledermatology – Next steps
Obtain MSP funding for store and forward teledermatology
Revisit options for long-term storage of images/consults
Add educational component with CME credit for GPs
For more information: Wingfield Rehmus [email protected] Shane Barclay [email protected]
Sarah Stephanson [email protected] Tristan Smith [email protected]
For more information Shared Care Committee
115 - 1665 West Broadway Vancouver, BC V6J 5A4
Tel: 604 736-5551 www.sharedcarebc.ca