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Dr. Shane Barclay, Dr . Paula Ryan

Teledermatology for BC A pilot project sponsored by the Shared Care Committee. Dr. Shane Barclay, Dr . Paula Ryan. Telehealth can help meet some of the challenges of remote health care. Two types of telehealth. “Realtime” Telehealth. Traditional format for telehealth delivery. Pros

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Dr. Shane Barclay, Dr . Paula Ryan

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  1. Teledermatology for BC A pilot project sponsored by the Shared Care Committee Dr. Shane Barclay, Dr. Paula Ryan

  2. Telehealth can help meet some of the challenges of remote health care • Two types of telehealth

  3. “Realtime” Telehealth • Traditional format for telehealth delivery. • Pros • Most closely mimics a face-to-face visit. • Visual and interactive advantages. • Cons • Significant coordination on either end of consultation • Significant human resource demand.

  4. Store and Forward Telehealth • Pros • Timing to suit all those involved in the process. • Can maximize technical and human resource utilization. • Cons • Minor delay in diagnosis and treatment compared to “live”. • Not all specialties are amenable to this format.

  5. Dermatology is Ideal for Telehealth • Diagnosis is based primarily on visual assessment. • Patient history is usually brief and standardized. • Can be easily recorded in electronic format. • There is a provincial shortage of dermatologists. • Excellent for patients who cannot travel to clinics: • Too far. • Too ill or debilitated (ICU, ER, wound-care patients).

  6. Store-and-Forward Teledermatology • Early research shows that this service is: • Reliable. • Time-saving. • Cost-saving. • Useful to “triage” dermatology patients. • Appreciated by both patients and referring doctors.

  7. Consult Derm™ • A Novel Platform for Teledermatology Jaggi Rao, MD, FRCPCAssociate Clinical Professor of MedicineDirector, Dermatology Residency Training ProgramDivision of Dermatology, University of AlbertaEdmonton, Alberta, Canada

  8. Consult Derm How it works • Referring MD • Sees a patient with a dermatological problem. • Takes a digital photo(s) of the patient’s problem. • Logs into Consult Derm. • Uploads the images and provides a brief history. • Teledermatologist • Logs into Consult Derm. • Reviews the images and history. • Provides: 1) an impression, 2) education, 3) management plan. • Referring MD • Logs into Consult Dermand reviews the consultation; triage.

  9. Consult Derm Teledermatology Studies • The diagnosis and treatment plan made over the system is as effective and comparable to those made in person. • Most patients (>80%) actually prefer teledermatology to live dermatology visits. • This form of teledermatology is very cost-effective to the system. • In Alberta, Consult Derm has reduced the average wait time to see a dermatologist from 104 days to < 3 days.

  10. Consult DermTM History • 2006: Consult Derm conceptualized. • 2007: Prototype completed. • 2008: Alberta Health & Wellness and NWT approval. • 2009: Several validation and efficiency studies performed. • 2010: Approved by Alberta Privacy Commissioner. • 2011: Approval in the province of Prince Edward Island Telederm Outreach created (virtual volunteering). • Currently: Over 400 referring MDs, >1500 consults per year, • used in nursing homes, ER, correctional institutes.

  11. Consult Derm Process for Family Physicians • The diagnosis and treatment plan made over the system is as effective and comparable to those made in person. • Register as a new referring physician by logging into consultderm.com. • Scroll down and click on BC.consultDERM.

  12. Consult Derm Process • Once registered you will receive an email confirming your registration.

  13. Consult Derm Process • See patient in office, either ‘on the spot’ or pre-booked. • Take history and enter into EMR. • Take pictures.

  14. Hints re Camera and Picture Taking • Type of camera. • AA battery vsrechargeable. • When taking pictures: • Don’t get too close to patient’s rash. • Don’t use high resolution. • Usually flash not needed as ‘washes out rash’.

  15. Consult Derm Process • See patient in office, either ‘on the spot’ or pre booked. • Take history and enter into EMR. • Take pictures. • Download pictures on to the PC. • Log into “consultderm.com”, choose bc.consultderm.

  16. Currently within a week or so you will receive an email alert stating you have a consultation waiting on ‘Consult Derm’.

  17. Consult DermTM BC: New Features • iPhone/iPad application

  18. Salt Spring Pilot Project • By February 14 , 2012 we had done 78 telederm referrals, from 5 family doctors. • Dr Jackie Cooper (R2- FP) did a cost analysis and patient satisfaction research paper.

  19. Salt Spring Pilot Project Patient Satisfaction • 95% of patients strongly agreed or agreed that Telederm was more convenient than going off island. 1 patient (5%) was ‘neutral’. • 100% were comfortable with pictures being taken and sent to a secure web site. • 73% of patients were confident the dermatologist could make an accurate diagnosis using telederm. • The remaining patients were ‘neutral’.

  20. Salt Spring Pilot Project Patient Satisfaction • Overall 86% were satisfied with the telederm consult. Only one patient was unsatisfied, due to time delay. • 86% of patients would rather have a telederm consult than go off island.

  21. Salt Spring Pilot Project Economic Impact • Average estimate of ‘loss of work income’ for going off island to a dermatologist was ~ $100/patient (range 0-$350). • Travel and incidental costs to patients going off island were ~ $120. (gas, taxi, daycare, parking, etc.). • Ferry cost (round trip) to: • Victoria $41.40. • Vancouver $119.45.

  22. Salt Spring Pilot Project Economic Impact • Total savings to both patients and MSP by treating 78 patients on Salt Spring Island: • ~ $19,600.

  23. Summary • Consult Derm represents a novel, tried and proven, unique service to improve access and quality of Dermatological care. • With improved imaging technology and wide availability of the internet, this service is a logical and immediate solution to the shortage of dermatologists in British Columbia.

  24. Thank You • BC.ConsultDerm.com • Drs. Paula Ryan and Shane Barclay on behalf of • JaggiRao, MD, FRCPCAssociate Clinical Professor of MedicineDirector, Dermatology Residency Training ProgramDivision of Dermatology, University of AlbertaEdmonton, Alberta, Canada

  25. Email Addresses for Telederm • Shane Barclay drsbarclay@gmail.com • Paula Ryan paularyan@shaw.ca • Jaggi Rao jrao@ualberta.ca • Neil Kitson nkitson@interchange.ubc.ca • Wingfield Rehmus wrehmus@gmail.com • Patrick Kenny pgwkenny@shaw.ca

  26. For more information Shared Care Committee 115 - 1665 West Broadway Vancouver, BC V6J 5A4 Tel: 604 736-5551 www.bcma.org

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