VIENNA Teledermatology is expanding in Europe through an online international dermatology community that provides open-access consultations, H. Peter Soyer, M.D., reported at the 10th World Congress on Cancers of the Skin.
The consultations are free of charge for now, and they are available in five different languages. Physicians can send in patient pictures and information, and may request a consultation with a specific clinician from a team of dermatologists. Discussion can be added from about 500 participating dermatologists worldwide.
The idea (www.telederm.org
The first world congress on teledermatology will be held in November 2006 in Graz.
Dr. Soyer said teledermatology provides not only a second opinion, but also greater access to care and disease monitoring in remote areas and third world countries. European dermatologists have also gained valuable experience about unfamiliar skin conditions reported by dermatologists in Pakistan and China.
Audience members responded positively to the presentation, but many Americans suggested that malpractice insurance will be needed for telemedicine to grow in the United States.
American physicians have been successfully sued for consulting on nondermatologic cases from states where they didn't hold a license.
"We do it bona fide, with good trust," Dr. Soyer said at the meeting, which was cosponsored by the Skin Cancer Foundation. "If you are taking care of the patient, you are responsible, and I am your assistant."
Dr. Soyer said liability is an unresolved issue and that a legal platform may need to be established to address liability for online consultations.
Reasonable liability insurance for telemedicine has been slow to happen in the United States, in large part because of limited reimbursement, Hon S. Pak, M.D., a member of the American Academy of Dermatology Telemedicine Task Force and vice president of the American Telemedicine Association, said in an interview.
Although third-party payers are increasingly reimbursing for telemedicine, the Centers for Medicare and Medicaid Services currently reimburses only for rural patientsdefined as patients who live in non-metropolitan statistical areasif teledermatology takes place in a live, interactive mode.
Except in federally designated clinics in Hawaii and Alaska, reimbursement does not exist for store-and-forward consultations that allow for asynchronous communication between clinicians via the Internet.
"It's not that teledermatology increases liability; it's just that insurers don't know enough about it and how to put a risk score on it," Dr. Pak said. "Enough volume has to be generated to get a risk profile, and that requires reimbursement."
Members of both the AAD task force and the ATA appeared on Capitol Hill this spring to educate legislators on the value of teledermatology and to push for reimbursement for store-and-forward teledermatology.
A teledermatology forum is also planned for the AAD annual meeting in 2006. The forum is seen as a way to encourage dermatologists to use the technology to enhance their practices, said Dr. Pak, who is a dermatologist with the Telemedicine and Advanced Research Center at Fort Detrick in Frederick, Md.
Other hurdles still exist for teledermatology. Transmission of multimedia streams has remained a major challenge for real-time consultations, and some asynchronous consultations may or may not provide clinical information, depending on what is requested.