The entity (Green Street Dermatology Associates) referenced in this illustrative case is fictional. Individuals, business, events and scenarios referenced are influenced by interviews and review of publicly available literature. Any resemblance to actual individuals, entities or events is purely coincidental.
Overview
Green Street Dermatology Associates is a midsize specialty practice that is located in an urban area and conducts about 6,500 visits annually. Green Street recently decided to adopt teledermatology capabilities (eVisits and interprofessional consultations) after patients and primary care practices in the area reported frustration with wait times for nonurgent dermatological consultations.
The practice is planning to implement eVisits, which enable patients to send a photo of their dermatological condition or complaint directly to their dermatologist through the practice’s online, secure patient portal. The practice’s dermatologists then review the images and provide treatment guidance through a portal message or recommend an in-person visit for further consultation. The practice has hired an interpreter to assist with store and-forward exchanges and ensure that all incoming and outgoing portal communication messages are translated for patients whose first language is not English.
In addition to store-and-forward, the practice has also decided to start providing interprofessional consultations to primary care providers in their network, connecting with them over video to provide live diagnostic support and review pertinent imaging sent by the primary care office.
Strategic goals
Green Street Dermatology Associates is adopting teledermatology to:
- Attract/acquire new patients and retain existing patients.
- Improve access and timeliness of care by mitigating barriers such as transportation, child care and language.
- Facilitate appropriate consultation and enhanced referral with local primary care providers.
Program impact on health care value streams
Clinical outcomes, quality and safety
Clinical quality and safety outcomes
- Relevant measures
Improvement in disease detection - Impact goals
Improve detection rate of cancers by 5%
Access to care
Availability of care
- Relevant measures
Time to third next available appointment - Impact goals
Reduce wait times to third next available appointment to under two weeks
Patient, family and caregiver experience
Clinical and/or technology experience
- Relevant measures
Net Promoter Score (NPS) - Impact goals
Achieve NPS for eVisit service of 50 or higher
Clinician experience
Work experience
- Relevant measures
Engagement and satisfaction with work (self-reported) - Impact goals
Increase clinician satisfaction rates by 25% on Green Street’s clinician satisfaction survey
Financial and operational impact
Direct revenue
- Relevant measures
Net patient service revenue - Impact goals
Increase net patient service revenue by 5% as a result of new patient growth
Indirect revenue
- Relevant measures
Dermatologist panel size - Impact goals
Increase panel sizes by 10%
Health equity
Patient experience
- Relevant measures
NPS by language - Impact goals
Achieve no difference in NPS by patient language
Examples of teledermatology programs
University of Connecticut: UConn Health has offered teledermatology since 2015 and covers patients across Connecticut and three clinics of Penobscot Community Health Center in northern Maine.
Kaiser Permanente: The Permanente Medical Group has offered teledermatology to patients in Northern California for over 16 years.
RubiconMD: Founded in 2013, RubiconMD provides a platform to enable interprofessional consults for over 125 specialties, including dermatology.
Relevant literature supporting illustrative impact estimates
Clinical outcomes, quality and safety
- A 2012 study found that teledermatology consultations resulted in a recommendation of initiation or discontinuation of a medication in 67.5% of the cases.
- Kaiser Permanente found that when dermatologists had the chance to look at well-photographed skin lesions, they were able to identify nearly 10% more cancers with almost 40% fewer referrals to the dermatology department.
Access to care
A 2020 study found that teledermatology led to a 78% reduction in the waiting time for in-person appointments when compared with usual care.
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