Guidelines for Implementing Quality Teledermatology During the COVID-19 Crisis

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A panel of dermatologists outline how to implement a telehealth structure that allows for sustainable and scalable practice beyond the current crisis.

Centers for Disease Control and Prevention (CDC) guidelines currently limit in-person care to the most urgent patients, but a 1135 Waiver issued by the Centers for Medicare & Medicaid Services (CMS) has expanded telehealth coverage for all Medicare patients during the coronavirus disease 2019 (COVID-19) pandemic.

A team of dermatologists has compiled guidelines for physicians who wish to use teledermatology in their practices; the recommendations were published in the American Academy of Dermatology.

When adopting teledermatology in an outpatient practice, the guidelines recommended the following 5 steps:

1. Use existing systems and platforms (patient portals) to encourage patients to initiate telemedicine when available.

2. Identify highest risk or urgent patients and schedule them for telemedicine visits.

3. Defer all nonessential visits until a later time.

4. Develop an established pathway for contact and evaluation for urgent patients.

5. Confirm that patients know there is a clear line of communication to minimize emergency department overuse for noncritical issues.

The waiver allows teledermatology to be used for the evaluation and management of most patients and removes obstacles that had prevented the use of teledermatology: lack of reimbursement, licensing restrictions, and HIPAA compliance issues. Physicians are urged to maintain high standards of professionalism and quality of care while conducting their practices via teledermatology platforms. Adherence to state regulations, thorough clinical intake, clear and consistent video connectivity and images, documentation, patient education and transparency, care coordination, data security, and patient privacy were cited as components of telemedicine that should be top priorities for practitioners. It was also suggested that if a non-HIPAA compliant platform is used initially, conversion to a HIPAA-compliant platform should be sought as soon as possible.

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Acknowledging that the implementation of a new patient care model may be challenging, the guideline authors wrote that use of telehealth during this pandemic will teach physicians how to allocate resources, improve efficiency, and optimize health systems. However, as exposure concerns and the risk for COVID-19 transmission make in-patient consultations improbable, “With telehealth implementation, we can see patients remotely, whereas we would not have seen them at all,” they said.

Reference

Lee I, Kovarik C, Tejasvi T, Pizarro M, Lipoff JB. Telehealth: Helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation [published online March 27, 2020). J Am Acad Dermatol. doi:doi.org/10.1016/j.jaad.2020.03.052