Penn Medicine Identifies Telehealth Benefits in Dermatology Consults

New research from the University of Pennsylvania and Independence Blue Cross finds that a telemedicine platform can reduce the wait for dermatologist consult from six weeks to less than six hours.

The study, published this week in Telemedicine and e-Health, adds to the growing library of evidence that telehealth can drastically improve the consult process for patients and providers without adding to a primary care practice’s workload or budget. And in reducing that wait, it hold promise to improve clinical outcomes by allowing for earlier treatment.

“Telemedicine offers the opportunity to accelerate health care access by getting around infrastructure barriers: namely, heavily booked dermatology practices,” Jules Lipoff, MD, an assistant professor of clinical dermatology at the Perelman School of Medicine and the study’s senior author, said in a press release. “Our study provides evidence that more patients can be cared for with the same amount of resources we’re using now.”

The study touches on several hot topics in connected health. eConsult platforms are growing in popularity as primary care providers, rural health clinics, federally qualified health centers and others look to improve access to specialists for their patients. In addition, researchers focused on the use of an asynchronous, or store-and-forward, telemedicine platform to share images between primary care providers and dermatologists.

The study also targets dermatology, one of the specialties often linked to telemedicine adoption. A safe and secure platform that allows providers to share images offers many benefits to the standard practice of sending images by mail or having the patient take images with him/her. An online platform also allows providers to access medical records and other data that could aid in diagnosis and treatment.

This researchers, meanwhile, focused on the fact that dermatologists are in limited supply, and an appointment with one often takes several weeks to arrange – particularly now, amid the coronavirus pandemic.

“The COVID-19 pandemic has illustrated just how important it is to ensure patients have the ability to access to the care, education and support they need virtually,” Aaron Smith-McLallen, director of Health Informatics and Advanced Analytics at Independence Blue Cross and a co-author of the study, said in the press release. “We see a future where more and more of our members will be using digital tools to complement in-person care and are working with our provider partners to make that a reality.”

“Video-based telemedicine has been extremely helpful amid the social distancing precautions brought about by the COVID-19 outbreak,” added Lipoff. “But we also need to look toward how we can expand other forms that may be more efficient in delivering care, such as ‘store-and-forward,’ since we’ve shown how effective they can be.”

The study was conducted in 2016-17 and focused on 167 patients, matched against a control group of 1,962 patients who took the traditional route of seeing a doctor, receiving a referral and scheduling an appointment with a dermatologist. By using telehealth to share images between providers, those in the first group were able to be “seen” by a specialist – specifically, to have the dermatologists review their case and issue a diagnosis – in about five hours, while the control group averaged 84 days between initial visit and dermatology visit.

“In addition to the dramatic reduction in time to consultation, the study also suggested that the difference in total medical costs did not significantly differ between the telemedicine patients and those in the non-telemedicine arm of the study,” the press release pointed out. “Moreover, there was not a significant increase in consults when telemedicine was used compared to the previous process.”

For the study, Penn Medicine trained clinicians in five primary care practices to use a telemedicine platform and recruited eight dermatologists to review the cases. The specialists were able to process those telehealth cases within their normal workflows.