PracticalDermatology

I have always been passionate about technology in health care, so much so that I even worked a few years ago with a small startup trying to build a telehealth platform. I’ve always been intrigued by technology and the ability to use it to better deliver care and provide access to care. This is especially pertinent to dermatology, since the specialty has such long wait times, and many patients find it challenging to get in to see us.

No one saw coming what happened with COVID-19, but as a specialty we now recognize that the necessary shift to telehealth in 2020 has permanently changed patient expectations and our delivery of care. As someone who has provided virtual visits for my patients since we launched our clinic in 2018, I now recognize that it has become imperative for practices to offer telehealth. Patient attitudes and demands have shifted, and we must embrace telehealth or risk losing the ability to effectively care for our patients.

Even after—or perhaps because of—the rapid pivot to telehealth in spring of 2020, many physicians continue to lack familiarity with the nuances of telehealth and its potential uses. Ahead, I will clarify come key aspects of technology in healthcare and discuss my personal approach to attracting and serving the digital patient.

The Digital Patient

The digital patient is really the digital consumer, armed with a smartphone (there are an estimated 1.6 billion or more people with smartphones around the world), who is seeking convenient ways to get care, even as the pandemic subsides. Digital consumers shop for cars and clothing. With the Amazon Prime model, many consumers now expect same day or next day delivery. And they see no reason that health care should be different. We use digital tools in every aspect of our life, and I believe that health care was the last frontier.

Digital Health

There are two aspects of the digital health revolution. There’s the digital health side—think of the Apple watch or the Fitbit—that is basically empowering a consumer or patient to take better care of themselves. The other side is telehealth or care delivery. We can use digital health platforms to engage patients and even attract new patients. We want to engage digital consumers and turn them into digital patients through telehealth.

Telehealth

Distinct from digital health, telehealth refers to how we deliver care, such as through virtual visits. The most beneficial approach for me, and I think for dermatology in general, is store-and-forward. Store-and-forward provides several benefits, including the ability to better manage our time. A number of straightforward dermatology cases can be efficiently managed via store-and-forward. Synchronous visits using teleconferencing technology simply present too many opportunities for technical errors, no-shows, inability to render a diagnosis due to insufficient image resolution, etc. Plus, unless the visit is recorded, which patients are unlikely to consent to and which would require excessive storage, documentation can be a challenge.

Dermatology is a visual specialty that is ripe for use of store-and-forward telehealth solutions.

Virtual Visit Platform

Documentation of the patient encounter is critical from both a liability and a billing standpoint. I built my own virtual visit platform that allows me to effectively offer and bill for store-and-forward. I created a form for documentation of the encounter through CognitoForms.com. The patient fills out all information, including their history, allergies, etc., as well as their insurance information, and they submit that form along with proof of insurance as well as any images of their skin concern. This process produces an electronic record that is auditable, verifiable, that meets the documentation requirements of insurers, and that enables me to use the GQ modifier. It documents my electronic (non-telephonic) communication with patients for care delivery.

I coded this form to integrate with my EHR platform (I use EZDerm). Each digital patient is placed as a virtual visit on my daily schedule. Among other benefits, placing the encounter on the schedule facilitates submission of prescriptions to the pharmacy—with documentation—and linking to the patient portal. When we submit prescriptions, we send a counseling note with information on those medications and the management plan to the patient through the portal.

To my knowledge, there is no single platform available to practices that can integrate all these aspects of the virtual visit, which is why I created my personalized solution.

As with an in-clinic patient encounter, follow up is critical. We follow-up via the portal, through emails, and, if necessary, by phone (note that this is for follow-up and does not constitute virtual care under current guidelines) if patients do not respond to our initial response to their telehealth assessment.

Paperless Practice

With the shift to EHRs, the notion of the paperless practice emerged. My practice truly is a paperless practice, leveraging technology solutions at every point in the patient care journey to increase efficiency and reduce waste.

Our EHR accommodates online booking and digital patient intakes. Of course, we have the patient portal. All billing is through the EHR platform, and we offer online bill payment. About one-third of our patients currently book online. Patients who are connected to their smart phones often prefer the option to book online without having to call the office. I submit that any practice that does not offer online booking is missing an opportunity.

My Experience and Additional Tools

One of the newer tools I’ve implemented in my practice is an app that bridges the gap between digital health and telehealth. The Miiskin app is designed to help digital health consumers track their skin health. Using AI technology, it allows patients to track changes in lesions and monitor response to treatment of cutaneous diseases.

In addition, the app can facilitate the transformation of its users into digital patients. Consumers on the app can identify a dermatologist subscriber for virtual assessment of their skin concern. As a dermatologist subscriber, I can triage the patient immediately. Some individuals with suspicious lesions will be contacted to schedule an in-person assessment and possible biopsy. Others with more straight-forward diagnoses will be directed to submit a virtual visit via our telehealth platform.

Since we launched Miiskin and began using it for patient triage in June 2021, 75 percent of patient submissions have resulted in a scheduled office appointment; 62 percent of those went on to become completed medical visits; some people simply no-show or cancel. We’ve recognized an average revenue of about $229 per patient. That figure is higher than the average office visit because these patients needed intervention, such as an excision and/or biopsy.

The monthly provider subscription cost is comparable to the fee received for a single typical office visit, which is a low cost for the opportunity to engage digital consumers and potentially convert them into a digital patient when they have a skin concern.

Practices that do not offer telehealth can still subscribe and use the app simply to attract digital consumers who may be otherwise unfamiliar with that practice. Each clinic is assigned a code, and patients may direct their queries to a specific practice. Even without the telehealth option, the app can reduce delays in care delivery by efficiently triaging patients and giving them access to board certified dermatologists.

Online Mindset

As the market and patient expectations evolve, dermatologists must be more attuned to the mindset of the digital consumer. This isn’t about any particular age demographic or practice location. Individuals of all ages in all locales have become digital consumers, and their expectations are affecting healthcare utilization. Embrace the various digital opportunities available to find the digital patient. Social media is another key tool, and it’s impossible to ignore online reputation, including Google reviews. Understanding the options and adopting those that make sense for your practice style can go a long way to growing your practice without adding significant stress.