The DermatologistOnCall app connects patients to a board-certified dermatologist via a virtual doctor's office. The patient logs in to the website, fills out a pre-screening questionnaire and uploads a photo and written description of their skin condition. Photos can be uploaded directly from a mobile device. Patients can elect to be "seen" by a specific dermatologist or by any available dermatologist. Patients receive a diagnosis and treatment plan within three days, with an e-prescription in states that allow it. If the doctor feels the patient's photo or description is inadequate, they can request more detail from the patient.
The app is intended to serve as an extension of an existing dermatology practice -- an additional service dermatologists can offer to patients. It's intended for common, non-urgent skin conditions like acne or poison ivy, not full body checks or serious skin conditions. If a doctor identifies a skin condition as serious, he or she can request that the patient come in for an in-person visit.
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According to Sarvenaz Mobasser, a Los Angeles-based dermatologist who isn't associated with the app, there are obvious benefits to mobile dermatology diagnoses -- as well as serious limitations. "Dermatology is a very visual field, but the visual aspect isn't everything," she said. "As doctors, we use all of our senses to figure out what's going on. Touch is a big part of this."
So are medical tools that provide a closer look at the problem. A dermoscopy, for example, is a device that magnifies the skin condition, letting the doctor see further into the skin. This closer look could lead to a more accurate diagnosis.
There are also certain descriptions that most patients simply wouldn't know to include. For example, a patient with purpura, red or purple discolorations caused by bleeding underneath the skin, wouldn't necessarily know whether it's palpable or blanching. "These are things the patient wouldn't even know to tell you," Mobasser pointed out.
Still, there's value to a three-day waiting period as opposed to the months it can take to get a dermatology office appointment. The app can also increase access for patients who might not have a dermatologist in their area. "With healthcare reform, there will be a large influx of new patients entering the system," said Mark Seraly, CEO of Iagnosis. "We need a new delivery system now to enable patients to get affordable and accessible care."
"The timing is aligned with technological and consumer preparedness," Seraly continued. "Patients are well-educated at being able to capture, store and forward digital images. Facebook has taught people how to do this."
Iagnosis rolled out the app in Pennsylvania and is in the process of rolling it out in other states. There's state-by-state legal red tape to work around because every state has different laws on telemedicine and electronic prescriptions. For example, Arizona doesn't allow electronic prescribing without a pre-existing, in-person doctor-patient relationship.
Iagnosis is also working to incorporate patient data into dermatologists' EHRs. Currently Iagnosis provides printable paper charts that can be scanned into the EHR.
"I think the app is valuable, but we have to be cautious about how it's used and what kind of diagnoses is made off of something like that," Mobasser said. "Doctors are probably going to make a good judgment call on diagnoses, but it certainly can't replace a real, live person."
DermatologistOnCall uses an out-of-pocket pay model. A "visit" costs $69.