When Disruption Spells Opportunity

Making the case for teledermatology in the new millennium.

By Dave Zynn

The healthcare delivery landscape, including the practice of dermatology, is being disrupted. More and more, the industry is becoming just as much of a market of consumerism as it is a service market.

Examples of healthcare consumerization are ample. Stand-alone urgent care centers are expanding in nearly every market. In fact, the American Academy of Urgent Care Medicine reports this number has grown from 8,000 facilities in 2008 to more than 9,300 in 2015. Many traditional health product and pharmacy retailers, such as CVS and Walgreens, offer in-store clinics that deliver a variety of services for minor illnesses, minor injuries, immunizations, and screenings. Plus, there is the dramatic growth in telemedicine offerings and rapid patient adoption. A recent survey from Austin, TX-based Software Advice put the number of consumers interested in receiving healthcare services via telemedicine at around 75 percent.

The patient, who may find wait times too long to see a regular doctor (even longer for a specialist), now has more care options than ever. Market growth in each of those areas shows s/he is willing to pay “retail” rates out of pocket for options.

The downside is that if a patient chooses a care option that is not designed (and accordingly staffed) for their specific needs, particularly for a specialty like dermatology, they might not get the correct care. More expansive consumer choice doesn’t mean all of those additional choices are fitting, particularly when health is at stake.

Opportunity Knocks

This “disruption” spells a tremendous opportunity for the practice of dermatology—a highly visual field that lends itself well to moving those visual assessments online. When patients have an option that includes teledermatology visits, they have an appropriate choice that also helps them hurdle two major obstacles: doctor access and wait times. The American Academy of Dermatology (AAD) puts the national average at 34 days for a patient to get an appointment, and there is a well-known shortage of dermatologists in the US (roughly 1 for every 31,000 Americans).

As patients evaluate all of the care options before them, particularly when faced with long appointment wait times and the opportunity cost of time lost in their schedules, they will soon expect dermatologists to offer a better solution. And as evidenced by the growing retail healthcare market, they are also willing to pay a bit extra for immediacy and convenience.

On average, a patient can save about 111 minutes by conducting their dermatology visit online as opposed to taking time out of their schedule to travel, wait for, and conduct their in-office appointment, according to our internal data. The total lost time doubles if a parent or other surrogate needs to accompany a minor child (who typically needs to take time out of school) or other patient to receive care.

Teledermatology helps a practice stay competitive with the urgent care centers, retail clinics, and general telemedicine apps that might attract patients yet deliver a misdiagnosis. Dermatologists are far more likely to accurately diagnose a skin cancer than a family doctor, at 87 percent compared to 22 percent,1 and a review of other published studies shows that the rate of general dermatology misdiagnosis among general practitioners floats between 40 to 60 percent.2,3 Teledermatology also provides an opportunity to re-capture the many patients who have a dermatologic condition but pursue non-dermatologist care.

Making the Case for Teledermatology

How can a practice affordably implement teledermatology to reach this highly sought patient population, and still maintain its current customer base?

Unlike extending the practice’s office hours, teledermatology allows the dermatologist to care for a greater number of new and existing patients without a correlating increase in overhead costs and staffing (other than the doctor’s own time). By conducting online patient visits, particularly using workflows that send or forward digital images and associated patient data to the specialist for storage and consultation, the dermatologist can do these visits at everyone’s convenience.

A common concern for dermatologists is that adding online care options will cost them existing patients. Instead, teledermatology gives practices the ability to be more strategic about patient care and in-office appointments. For example, visits that are “low touch” and can be diagnosed and treated by visual observation are ideal for online visits that include digital photo uploads. Other online visit types include follow-ups for acne or post-procedure to check wound healing. These changes benefit existing patients through time savings.

By shifting certain visits to the online format, the office’s appointment book, exam/procedure rooms, and staff time are freed up to handle higher-touch and more complex visits, such as annual full body exams, biopsies, and the range of other surgical and cosmetic procedures. This also paves the way to take on more new patients, who might otherwise be turned away or look elsewhere if the appointment wait time is too long.

Teledermatology helps retain existing patients who might explicitly desire an online visit option in the future. It’s ideal to the practice that existing patients conduct teledermatology visits with their current provider as opposed to going elsewhere.

And teledermatology is catching on fast. The DermatologistOnCall platform has seen 3X growth in the number of providers using its platform just in the past year alone, and patients seem to like it, too: Fully 97 percent of online-surveyed patients said they’d recommend the service and that they were moderately to extremely satisfied with their online dermatologist’s diagnosis and treatment plan. Several other dermatology-focused apps have entered the market in the past few years, creating a new competitive cottage industry that will further add to the consumerism of healthcare.

Disruption is a word that carries a lot of negative baggage and might raise eyebrows in the healthcare field, but it can bring much positive change in a consumer context. ATMs were disruptive to banking, but there is still need for retail banking locations. E-commerce was disruptive to shopping, but we still need stores and shopping malls. In dermatology, disruption will do the same: shift “transactional” in-office patient visits to a more efficient, economical, and scalable process that brings more (not fewer) patients into the treatment tent.

Behind this disruption are two crucial dynamics: growing consumer interest in telehealth options and unsatisfied dermatology service demand, which when combined, create a “perfect storm” for the new solution paradigm of teledermatology. n

Dave Zynn is CEO of Iagnosis, Inc. in Pittsburgh, PA, the parent company for DermatologistOnCall®. He can be reached at dzynn@iagnosis.com.

1. Morrison A, et al. “Suspected skin malignancy: a comparison of diagnoses of family practitioners and dermatologists in 493 patients. Int J Dermatol. 2001 40(2):104-7. http://www.ncbi.nlm.nih.gov/pubmed/11328390

2. Lowell BA, Dermatology in primary care: Prevalence and patient disposition.

J Am Acad Dermatol. 2001 Aug;45(2):250-5.

3. AAD. Position Statement on Cost-Effective Dermatologic Care (Approved by the Board of Directors July 17-18, 1993.)


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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.