Store-and-forward model could be the future of teledermatology | Panda Anku

August 23, 2022

4 minutes read


Disclosure: Friis claims to be the founder and CEO of Miiskin.

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Telemedicine has evolved dramatically in recent years and its growth has been exponentially accelerated by the COVID-19 pandemic.

In dermatology, telemedicine has benefits for patients and providers alike. Healio spoke to Jon Friis, Founder and CEO of Miiskin, a teledermatology platform, about how teledermatology has evolved and where it is heading in the future.

Q: How has teledermatology evolved over the past decade and how has the COVID-19 pandemic impacted its growth?

Jon Fries

Frieze: The different fields of teledermatology have evolved a lot in recent years due to the technological advances of the last decade and the introduction of smartphones. Particularly impactful have been the recent natural developments in the reimbursement system and the enactment and passage of telemedicine parity laws in many states across the US, giving patients the right to receive telemedicine when needed and private payers the obligation to cover the telemedicine visit on the same level as a physical consultation. This is a huge win for teledermatology and brings with it so many efficiencies. The reimbursement and coverage infrastructure is finally mature, ensuring providers can secure profitable televisits as a natural part of day-to-day operations and meet the demand of the growing population of digital patients.

I think one of the key takeaways during COVID-19 was that live video conferencing didn’t really make sense for dermatologists. It takes the same amount of time as an in-person visit, but doesn’t have the same quality or efficiency. The future of teledermatology is store-and-forward solutions, direct to the patient and supported by high-quality images and clinical questionnaires that are answered by the patient before visiting the doctor.

Q: What are the main benefits of teledermatology for patients and providers?

Friis: For patients, store-and-forward teledermatology allows them to initiate access to care from the comfort of their own home, and if something is found critical, they are prioritized. For example, when it comes to skin cancer or melanoma, the care process can be initiated without driving, making appointments, and taking time off work, making it easy to fit into a busy life.

For the clinics and providers, they can finally meet the increasing demand of digital patients while increasing efficiency and throughput. They are able to manage digital patients for no-shows and cancellations while also converting telemedicine visits into profitable digital consultations, especially at lower costs related to skin conditions (such as mild to moderate acne, rashes and eczema), medication refills and triage for birthmarks and lesions. Some dermatologists estimate that over time, 30% to 50% of consultations can be handled via store-and-forward digital platforms, which I believe will play a pivotal role in the fight against burnout and staff shortages due to the increase in capacity providers can utilize to better balance the workload or to care for more patients.

Q: What are the disadvantages of teledermatology for both patients and providers?

Friis: Live video conferencing comes with a number of complexities such as: B. lower quality documentation and the same or more time investment per patient. The synchronous nature of the visits is another complexity – the patient can spend a lot of time setting up the video call and is easily delayed, leaving the provider idle.

Asynchronous store-and-forward offers advantages over live video conferencing. The patient and the dermatologist do not have to be present at the same time. There is high quality of digital images and documentation, and the patient can prepare the documentation of the skin condition before visiting the doctor. In addition, there is a fast feedback loop to the patient and the doctor has the opportunity to prioritize necessary physical consultations if necessary.

It is important to say that only part of the telemedicine inquiries – 30% to 50% – can be completed directly via telemedicine and the rest can then be attributed to a physical consultation depending on the skin problem that has now been verified. This leaves the clinics with an efficiently prepared physical consultation with the right service provider.

Q: When should patients opt for teledermatology appointments and when should they be seen in person?

Frieze: In general, teledermatology works most efficiently for less severe skin conditions such as mild to moderate acne, some rashes and burns, medication refills, eczema, etc., but also to triage skin lesions and birthmarks. It will always be the dermatologist or provider who chooses which patient requests are appropriate for telemedicine – not the patient.

Q: How have dermatologists adapted to teledermatology practices in recent years?

Frieze: It was a slow start, especially as reimbursement – private payer coverage – had to mature to create an infrastructure where providers could claim coverage that matched face-to-face consultations. This has now happened with the passage of the parity laws. I believe there are about 30 states that have passed some sort of parity law and the rest will most likely follow in the next few years.

Q: What are the biggest hurdles for clinicians when using teledermatology technologies?

Frieze: Technology and solutions are easy and safe to set up and at a very affordable cost. One of the biggest hurdles is knowing and educating about the difference between live video conferencing and store-and-forward teledermatology. Another hurdle is creating awareness that private payer coverage is under parity laws – and of course which CPT code to use for that.

Q: How can teledermatology improve care?

Frieze: This is a huge improvement for the patients. You can start the care process quickly and conveniently from home. Many states have to wait months to gain access to a dermatologist. We had patients on our platform who were diagnosed with skin cancer by a dermatologist within days instead of the traditional months in line. Others have received acne medication prescriptions within 24 hours based on patient-reported images and documentation, greatly improving treatment time and efficiency.

Q: Where do you see teledermatology going in the next decade?

Frieze: In particular, the move away from live video conferencing solutions towards store-and-forward solutions, and I firmly believe that a personal skin imaging app technology is the enabler to move the industry towards store-and-forward teledermatology . Capturing good images of patients at home is not trivial and needs the additional support of artificial intelligence, machine learning and camera augmentation. With the reimbursement in place and the app tools available, we should see this shift begin now. In the case of minor skin problems, it is not necessary to visit a dermatologist in person.

Q: How can clinicians help advance telemedicine initiatives?

Friis: You can read about parity laws and store-and-forward teledermatology solutions. We have many articles and whitepapers on these topics on, and you’re always welcome to contact us if you have any questions about reimbursement and CPT codes, or if you want to understand how technology can facilitate online patient visits.

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