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9/4/2013
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Virtual Dermatology Is Here, But Does It Work?

Iagnosis' new app allows dermatologists to virtually diagnose patients with common skin conditions.

Remote Patient Monitoring: 9 Promising Technologies
Remote Patient Monitoring: 9 Promising Technologies
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The market for healthcare apps is booming -- from apps that monitor your daily activity to apps that keep track of your medication compliance, the motto has become "There's an app for that." Iagnosis, the developer of a new dermatology diagnosis app, is capitalizing on this mindset.

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.

[ Telemedicine: remote possibilities? Read Telemedicine Improves Patient Outcomes: Study. ]

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.

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jaysimmons
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jaysimmons,
User Rank: Apprentice
9/13/2013 | 12:42:10 AM
re: Virtual Dermatology Is Here, But Does It Work?
This is yet another example of how telemedicine can make life easier for both patients and for providers. With a visual field like dermatology it makes sense that there be a remote app that can allow patients to remotely connect with physicians. Being that this is a visual app, my guess is that the physicians are going to use their judgement as to whether they can remotely treat the patient or not.

Jay Simmons
Information Week Contributor
ChrisMurphy
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ChrisMurphy,
User Rank: Author
9/5/2013 | 10:41:35 PM
re: Virtual Dermatology Is Here, But Does It Work?
I'm a believer in telemedicine for both cost savings and customer convenience, so this looks intriguing, but I don't think people will go for the 3-day wait. Amazon can get calamine lotion to my door in less than 24 hours, but you need 3 days to look at my picture and tell me it's poison ivy? That's the digital business mentality.
mseraly
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mseraly,
User Rank: Apprentice
9/5/2013 | 9:17:35 AM
re: Virtual Dermatology Is Here, But Does It Work?
I would like to briefly comment on some of the limitations Dr. Mobasser alluded to:Dermatologists rarely need to GǣtouchGǥ something to be able to
satisfactorily diagnose. We are not able to touch or palpate lesions whenever we take our boards, acquire
continuing medical education credits, perform self-assessment and
re-certification examinations or continue maintenance of learning as required
by the American Board of Dermatology. All of these exercises as visual only.
DermatologistOnCall is a fully scalable web-based virtual office platform. The intent of our application is for dermatologists to diagnose, treat, and counsel the myriad of common, low-risk, acute care, and non-urgent dermatologically conditions, the very conditions that patients no longer have timely access to our services due to long waiting times thus enabling in-office slots for patients who really need them for more serious skin diseases. Virtual care (store and forward teledermatology) has already been shown in peer-reviewed evidence based medicine to be just as diagnostically reliable as in-office face-to-face encounters. At Iagnosis, we believe that our platform is just another tool that dermatologists can use as an extension of their practices to better service their patients and enable affordable and accessible skin care by the most qualified group to do so...board-certified dermatologists.
Mark P. Seraly, MD
CEO Iagnosis
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