Before COVID-19, dermatologists ranked among the least likely physicians to use telemedicine. An international survey1 of 1,392 physicians showed that, pre-pandemic, dermatologists saw only 5% of their patients via telemedicine, the lowest percentage among the eight specialties surveyed. However, pandemic-related decreases in patient volume averaging 50% by April and the clear need to find ways to provide non-emergency healthcare services when state governments mandated once closures made the shift from in-office to online practice a priority, if not a necessity.
Many dermatologists caught up quickly, learning valuable lessons along the way. At the pandemic’s peak, dermatologists saw 57% of their patients remotely, a level commensurate with that of other specialties, according to the survey.1 “Telemedicine has been a complete lifesaver,” says Joel Schlessinger, M.D. Dr. Schlessinger, an Omaha, Nebraska-based board-certified dermatologist and cosmetic surgeon and CEO of LovelySkin.
One of the drivers for that dramatic uptick came from the federal government and various insurers who began waiving restrictions on telemedicine in mid-March to encourage quick adoption by healthcare providers.
“That’s exactly what we did,” says Adam Friedman, M.D., professor and interim chair of dermatology, George Washington School of Medicine and Health Sciences. “It’s very hard to make such a pivotal change in one’s practice. But we did a pretty good job.” Schlessinger adds that, with the help of his practice’s electronic medical records (EMR) vendor, Nextech, “We were up and running for telemedicine within three days of asking them about it.”
Offering telemedicine is one thing; optimizing it is another. First, Dr. Friedman’s practice got Zoom (Zoom Video Communications) licenses for all its team members, including residents. “It was a learn-as-you-go approach. We learned a lot of simple things that enhanced the experience, ensured timeliness and got the most out of telemedicine as we went along,” he says. Initially, Dr. Friedman’s patients were reluctant. “This is something completely new to these patients — especially in certain populations who don’t have technology literacy or access to technology.”
To address that, Dr. Friedman’s schedulers use a script to help “sell” telemedicine. If a patient doesn’t understand the process, a staff member walks them through a typical telehealth appointment and explains how patient safety and information security are maintained.
Still, glitches persist. For example, when a patient schedules a telehealth visit, a staff member immediately sends a detailed email explaining how to download and use Zoom. “They’re given all the information,” Dr. Friedman says. “But we found that, when you get to the time of the visit, the patient says, ‘What’s Zoom?’”
To address that, staff members now call patients at least five minutes pre-appointment to confirm that they have the necessary information, are comfortable with the technology and are in a Zoom-friendly setting. “Lighting, location and how you hold your tablet or device can make or break the visit in terms of being able to see,” he says.
The prep call — and an illustrated best-practices patient handout — are game changers, says Dr. Friedman. “We can move very fast, instead of spending half the visit trying to get patients on Zoom.”
Granted, telemedicine cannot fully replace seeing patients in-office, say Dr. Friedman and Dr. Schlessinger.
“It took a while to become efficient in telemedicine,” says Dr. Schlessinger. “It was never as efficient as seeing the patient in the office, frankly.” For example, if the doctor identifies a suspicious mole during a telemedicine visit, the patient will need a second in-office visit for evaluation of the mole. Previously, that would have been addressed in a single appointment. The time required for this two-step process creates severe…