Back in 2007 OTN’s primary focus was extending telemedicine – in the form of real-time videoconferencing – beyond hospitals, but we were also examining how to expand our program offerings. “Store forward” – an application that allows information to be sent to a secure server where it can be downloaded at another time – had been used for years in the United States, in particular, at Veterans Affairs and the Alaska Federal Health Care Access Network (AFHCAN). There were also a number of papers and presentations delivered at ATA on store forward use in dermatology. OTN decided to adopt it as a new/additional program offering in the Summer of 2009.
Many skin lesions can be diagnosed with a digital camera and a diagnosis can be given
in as little as 5 days; sometimes a biopsy is required that a local surgeon can perform.
Using Teledermatology, a primary care provider can deliver the information virtually to a specialist who provides a professional assessment and treatment plan. It’s a lot more convenient for the patient and results in very timely care, as the time to get a specialist assessment can happen in a few days instead of the weeks or months associated with a traditional face-to-face appointment.
Admittedly, not all conditions can be imaged for the consultant to make a diagnosis – some conditions are hard to diagnose from a photo and others will need biopsies which may require an in-person visit to the consultant.
As the technology matures it will become easier for the primary care provider to know what sorts of cases are appropriately referred for store forward versus face-to-face appointment.
As the technology matures it will become easier for the primary care provider to know what sorts of cases are appropriately referred for store forward versus face-to-face appointment. My estimate is that 60%-75% of skin lesions can be adequately imaged and assessed by a consultant with store forward technology.
OTN chose dermatology as one of the first clinical area to explore using store forward largely because it could be done so effectively. OTN is now expanding its use of store forward to other therapeutic areas of care, including:
- retinal imaging
- wound care/wound assessments
- psychiatry
The model of care is similar: a primary care provider sees the patient and determines whether an assessment by a specialist is required. The primary care provider takes the requisite photos or, in the case of psychiatry, video, from the location in which the patient is presenting, and uploads it to a server where a specialist can review it to provide a diagnosis or plan of care.
