The COVID-19 pandemic accelerated the implementation and adoption of digital services into many practices, and there are many practitioners who believe that, even after a return to normalcy, the use of digital access to care will continue.

As it has evolved, telemedicine is not only a means of providing physician access to patients reluctant, or unable, to attend an in-office examination — it can serve as an initial consult, a follow-up, or monitoring opportunity.

Margareth Pierre-Louis, MD, spoke with us about the success her practice, Twin Cities Dermatology in Minneapolis, Minnesota, has experienced since introducing a smartphone app program.


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Even before the COVID pandemic, Dr Pierre-Louis realized she wanted to reach more patients. “It doesn’t make sense for someone with a lesion to have to wait 3 months” to be seen by a clinician, she said. Patients were already experiencing delays accessing a dermatologist, but the restrictions instituted to decrease viral spread set these hurdles even higher. In fact, they put a lot of what patients once took for granted out of reach.    

From Digital Consumer to Digital Patient

The solution? A patient’s very own smartphone, because as Dr. Pierre-Louis pointed out, during the pandemic patients became more adept at ordering groceries, conducting business meetings, and communicating via mobile devices. “The consumer is now becoming the digital patient — someone who wants convenient, on-demand care, and they want it now. And that’s not a bad thing.”

As she sees it, the Miiskin app used in her clinic gives her patients that opportunity as the tool “allows the digital consumer to become the digital patient.”

MD on Demand

The long wait times experienced by patients in a traditional health care setting — calling for, booking, then waiting up to 3 months for an appointment — may factor into dermatology’s high no-show rates and cancellations. However, as Dr Pierre-Louis describes, “the digital patient is disrupting health care. The digital patient with that smartphone will reach out to a digital health platform. They want access.” That expectation of an immediate response means that patients “will determine who will survive in this new environment” as patients increasingly want their “MD on demand,” she explained.

How does this new care expectation affect the dermatologist? Dermatology is a specialty based on the visual, and an image captured and submitted by a patient is an entry point to care, she related. Patients will want a dermatologist trained to review digital images as well as provide a timely intervention. This insistence on convenience benefits both the dermatologist and the patient, she believes.

Unlike some countries with a national health care system, the United States has a consumer-driven health care market: patients choose their provider. This also allows patients to dictate how they prefer to receive their health care – in-person or online. Those physicians offering a choice will therefore appeal to more potential patients.

From Submitted Image to New Patient

The Miiskin app, which Dr. Pierre-Louis uses in her office, is a telehealth platform designed to optimize care delivery through triage and focused medication refill virtual visits. The free app is available for download from iOS and Android app stores, and clinics utilizing the platform provide a code to their patients.

According to Dr Pierre-Louis, the app generates new patients for her practice as anyone with a skin concern can seek out a practice that offers digital review. That digital review, in turn, then allows for facilitation of faster care delivery through triage, removing any delay in intervention. This is a selling point for a practice as the digitally enabled quick turnaround is appealing to most patients and is only limited by a patient’s access to, or comfort with, the app technology.

Although traditional patients are typically booked out 3 months in advance, at her clinic during an initial call the patient is offered the opportunity to download the app, enter the clinic code, and submit an image. The platform allows clinicians to “see” the patient more quickly via shared high-definition images coupled with the patient’s own report of their symptoms. This initial case review lets the physician prioritize patients based on urgency while reducing or eliminating the need for many typical booked appointments; more time is then available for an in-office opportunity for a high-priority or traditional patient who does need to be examined by the dermatologist.

As Dr Pierre-Louis explained it, the technology offers clinicians 7 core benefits:

  1. Reduced scheduling wait time, as patients can be prioritized and seen faster.
  2. Reduces in-office wait time, giving office staff time to prepare for patients/procedures before scheduled office visit; and patients the flexibility to complete intake forms from home.
  3. Reduced delays in care delivery, as patients are seen immediately if they have issues that warrants immediate attention.
  4. Increased productivity, with the staff appropriately triaging cases to in-person or virtual visits as needed.
  5. Reduced revenue loss from no-shows and cancellations.      
  6. Reduced health care waste and costs. Patients who might otherwise have sought emergency department or urgent care services have access to specialist expertise.
  7. Self-monitoring capabilities, which offer patients the ability to track their care and monitor treatment outcomes from captured images.

Dr Pierre-Louis recounted that there were approximately 200 downloads of the app in 4 months at her practice, resulting in 91 submissions that were directed through the triage process and brought a new patient into her office. “In other words, that’s 91 patients I otherwise would not have been able to capture,” she said. 

Giving the Patient What They Want: Convenient, Effective, On-Demand Care

“The digital patient wants care now, and why not? They want you because you are available to them,” she reiterated. Beyond availability, Dr Pierre-Louis reminds doctors that patients can choose a care provider based on area of expertise and suggests that the app offers potential for patients to choose a clinician with skin of color expertise or choose a provider based on other factors important to them. That gives people power — to have choice and to make a choice. Beyond that, you are giving them a tool that is HIPPA compliant, on a secure platform, and uses AI tech and face-recognition features.”

Miiskin app facilitates care triage and supports clinicians to convert the submission to a doctor-patient relationship for legal protection and to deliver care. Care can then be delivered virtually or in-office. No-show rates are higher for patients who booked their appointment traditionally than for patients who enter the system through Miiskin.

A telehealth presence will allow care providers to meet the patients’ needs more effectively and efficiently. “I believe the old brick-and-mortar approach to health care — in which you call, make an appointment, and be seen 3 months later — is outdated and contributes to health disparities and delays in diagnosis and intervention. We can do better than that.”

“COVID was an affirmation for digital [care] and telehealth. The tools were there. The digital revolution is not going to stop. We will not go back to waiting an hour in a waiting room to see a dermatologist. Patients will look for more tools to give them convenient, on demand care.” Her advice to practitioners is to “embrace the digital patient to help more people and make a bigger difference.”

Dr Pierre-Louis cited data gathered from her clinic, Twin Cities Dermatology, from June 3, 2021, to September 2, 2021.

  • 71 patients made requests for assessment of one or more photos taken within Miiskin and 75% of those resulted in a scheduled appointment.
  • 56% of those patients who made requests for assessment were new patients who might have been lost to appointment scheduling delays if their concern could not have been visualized and prioritized as urgent.

  • 83% of the scheduled appointments were actually performed. In total, 100% of the virtual consultations were performed.
  • The average revenue per patient per completed visit was $229.65.
  • Overall earnings from patients who submitted a request for assessment via Miiskin in the 3-month period was $10,105. The cost of Miiskin to her facility in the same period was $1800. The resultant return on investment for the implementation of Miiskin was ($10,105 – $1800)/$1800 = 461%.

Disclosure: Dr Pierre-Louis serves as an advisor to Miiskin and thus receives compensation.