Teledermatology

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The challenge for building a connected world in healthcare is dealing with the mission-critical nature of healthcare transactions, the lack of data standardisation, and concerns over security and privacy of healthcare information. Solutions need to scale to the potential of millions of simultaneous users, they must be available without fail, 24 hours a day and they must respond quickly to the demands of fast-moving professionals. Most importantly, citizens must be feeling absolutely confident about the sanctity of their personal information.

The term e-health only poorly defines the nearly unlimited number of communication procedures and technologies, ranging from telephone and fax through e-mail and digital data transmission of any kind of information in the healthcare market, including telemedicine. Other e-health tools include health information networks, electronic health records, personal wearable and protable communicable systems, and health portals to name but a few. So, e-health includes tools for health authorities and professionals as well as personalised health systems for patients and citizens. When combined with organisational changes and the development of new skills, e-Health can help to deliver better care for less money within citizen-centred health delivery systems. And dermatology, a medical discipline having great impact on the well-being of patients and citizens, might even serve as a paradigm for a medical branch facing successfully the challenges of e-health.

Telemedicine and in particular teledermatology, however, refers to a more stringent definition of e-health. The World Health Organization (WHO) defines telemedicine as “the practice of healthcare using interactive audio, visual and data communication. This includes healthcare delivery, diagnoses, consultation and treatment as well as education and transfer of medical data.” Telemedicine hold great potential to revolutionize medical and paramedical services, not only for primary care physicians in remote areas, but also for teaching students and for continuous medical education.


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[edit] Types of telemedicine

Principally two methods can be applied.

(1) The full-motion realtime video is the most interactive one. However, this system has to consider time-zones. The technical effort is big with respect to room, illumination and video-camera equipment. There also have to be special skills in order to have optimal transmission of the skin-lesion in discussion and in order to minimize discomfort for the patient and for the doctor.

(2) Store-and-forward communication is independent from time-zones. The technical equipment, including digital camera and a fix inbuilt light-source (flash) is less expensive and provides higher quality pictures than a cam-camera as used in the full-motion video-transmission. Moreover, pictures can be corrected electronically before transmission and can be labelled with annotations.

[edit] Legislation

Data security is a must as in all other areas of applied medicine. No new laws have to be created, since it makes no difference, if patients-data are transferred by writing, talking or electronically. For consulting purposes, the patient usually has no objectives against transferring the data in order to get a second opinion. For continuous medical education-purposes and teaching-purposes the situation is different in so far, that the patient has explicitly to give his agreement for using individual pictures or data.

With respect to the diagnostic or therapeutic responsibility again, there is no difference from “classic” patient-management: the responsibility always is with the physician, who takes direct care for the patient.

[edit] Applied Teledermatology

Patient-to-Physician-consultation via electronic data-transmission raises some legal questions. The more appropriate application of teledermatology is discussing medial problems between two (or more) physicians, especially between general practitioner and a specialist. One of the partners also may be a paramedical person (Paramedical Personnel), taking care of patients in the periphery, asking for some report during follow-up of patients with chronic diseases.


[edit] The telederm.org platform

A programme with worldwide coverage has been launched by the Department of Dermatology, Medical University of Graz, Austria, on the domain http://www.telederm.org under the auspices of the International Society of Teledermatology (http://www.teledermatology-society.org).

The basic aim of the project is to create a user-friendly platform for a teleconsultation service where physicians can quickly and easily seek diagnostic advice in dermatology from a pool of expert consultants and where they can present and discuss particular dermatological cases with emphasis on diagnostic procedures, diagnosis and therapy.

There are other Web sites offering free dermatology information, at least partially provided by users. For example, dermatlas.org (http://dermatlas.med.jhmi.edu/derm/index.cfm) is one of the largest dermatologic atlases supported by users' images. The Dermconsult Web site (http://www.dermconsult.com.au/) is an Australian, private, discretionary, educational Web site, login and password protected, which includes a virtual clinical meeting where dermatologists can post interesting cases with clinical data and images. The Virtual Grand Rounds in Dermatology (http://www.vgrd.org/index.html) also regularly posts cases in clinical dermatology open to users' opinions.

[edit] Teleteaching

E-learning programmes provide new didactic possibilities as they can be a unique blend of text, pictures, graphics, animations, audio and video. A significant advantage of e-learning is interactivity, which allows fast bilateral feedbacks between user and provider and is a key to motivation and control of the learner as well as an important help in programme development. Interactivity leads to more participation, which results in higher levels of cognitive engagement, to more retention.

Nevertheless, e-learning programmes can neither completely substitute a good textbook nor a good lecture. Since it is much easier to put a simple collection of pictures or lecture slides on the web than to create an interactive programme, providing profound theoretical and clinical knowledge in an interesting way, providers are easily seduced to neglect the theory part, overemphasising the visual aspect of dermatology. Only if suitably prepared, e-learning programmes will lead to more effective and faster teaching and learning. E-learning programmes have to be designed by a team of experts of dermatology, didactics and computer skills and these programmes need continuous and persistent care.

The role of the teacher should move towards support for the learner and not the delivery of knowledge. In the future, teachers will spend more time on instructional design of e-learning programmes, which open the ways of national and international networking between faculties and medical disciplines.

Among 16 e-learning programmes, offered on the web so far, only one cyberderm-doit (http://www.cyberderm.net) fulfilled most of the requirements of a complete, interactive, well-interlinked and didactically elaborate multi-language programme.


[edit] Future prospects

In the future, consulting and asking for second opinion will be the gold standard of medical care, which will be beneficial especially for patients and medical or paramedical services in remote areas. Quality of healthcare will be improved without saving direct costs. However, indirect costs such as time and effort for the patient and the citizen will be reduced.

Medicine in general and Dermatology specifically, still encounters some resistance of various forms, including physicians, patients, the general population, politicians, insurance-companies and healthcare-providers. However, there is no way back and it is our duty to contribute to the future development by giving support in designing the future of a modern health-care-system.

So, easy access to expert medical information and counselling of individual human beings independent from social, economic, ethnic and topographic aspects, a major goal of medical policy today, will be realized by the implementation of e-health tools and dermatology will meet this challenge.

European Commission (2004) e-Health—Making healthcare better for European citizens: An action plan for a European e-Health Area (http://europa.eu.int/information_society/doc/qualif/health/COM_2004_0356_F_EN_ACTE.pdf).


[edit] See also

[edit] References

  • H. Peter Soyer et. al.: telederm.org: Freely Available Online Consultations in Dermatology,

PLoS Medicine Vol. 2, No. 4, e87 DOI: 10.1371/journal.pmed.0020087, 2005: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020087

[edit] External links

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