INTRODUCTION
In the COVID-19 pandemic, academic institutions had to drastically alter their practices. Whereas many dermatologic procedures were canceled, the evaluation of many medical dermatology concerns and of cutaneous lesions continues, albeit with a heavy reliance on teledermatology. This is especially true in academic dermatology departments, which have historically formed the majority of teledermatology users.1 As academic dermatology migrates to teledermatology, there have been many considerations regarding the limits of teledermatology.
One initial consideration was the ability to get reimbursed for telemedicine visits. Previously, teledermatology was reimbursed at a lower rate; however, the recent reimbursement changes by the Centers for Medicare and Medicaid Services allow providers to be reimbursed in a fee-for-service manner.2,3 This change alleviates some of the concerns regarding compensation.
The second consideration is the teledermatology may provide an opportunity to optimize and standardize the practice. In private practices, a wide range of software is used. The American Academy of Dermatology has a series of recommended electronic records vendors; however, these are largely for private practice dermatology.4 In academic medicine, electronic medical records are based on the needs of the entire institution, and teledermatology services are frequently divided between store-and-forward and synchronous forms. In reviewing the literature as well as conducting an informal survey regarding platforms used in various academic dermatology programs, Epic is primarily used for synchronous teledermatology. These encounters include virtual video visits as well as phone calls made through the platform via Zoom.5 Store-and-forward practices tend to be conducted using platforms added to Epic by the individual institutions. For synchronous practices, an important consideration in examining Epic’s role as the most used platform is its contractual agreement optimization of teledermatology practices. Understanding the current landscape of academic with the video-communications company Zoom. Since 2017, Epic is the only electronic health company permitted to run Zoom’s application program interface (API). This interface facilitates Epic’s use in teledermatology, as it allows physicians to synchronously address their patients’ dermatologic concerns.
With the onset of global pandemics and the massive shift to teledermatology, the unifying platform provides an opportunity to create a standardized and optimized virtual visit. To date, the prevalence of the different types of electronic medical records used in large academic practices has not been well studied. Larger, more comprehensive studies as well as guidelines to optimize the practice of teledermatology are needed as we continue improve digital dermatologic care.
One initial consideration was the ability to get reimbursed for telemedicine visits. Previously, teledermatology was reimbursed at a lower rate; however, the recent reimbursement changes by the Centers for Medicare and Medicaid Services allow providers to be reimbursed in a fee-for-service manner.2,3 This change alleviates some of the concerns regarding compensation.
The second consideration is the teledermatology may provide an opportunity to optimize and standardize the practice. In private practices, a wide range of software is used. The American Academy of Dermatology has a series of recommended electronic records vendors; however, these are largely for private practice dermatology.4 In academic medicine, electronic medical records are based on the needs of the entire institution, and teledermatology services are frequently divided between store-and-forward and synchronous forms. In reviewing the literature as well as conducting an informal survey regarding platforms used in various academic dermatology programs, Epic is primarily used for synchronous teledermatology. These encounters include virtual video visits as well as phone calls made through the platform via Zoom.5 Store-and-forward practices tend to be conducted using platforms added to Epic by the individual institutions. For synchronous practices, an important consideration in examining Epic’s role as the most used platform is its contractual agreement optimization of teledermatology practices. Understanding the current landscape of academic with the video-communications company Zoom. Since 2017, Epic is the only electronic health company permitted to run Zoom’s application program interface (API). This interface facilitates Epic’s use in teledermatology, as it allows physicians to synchronously address their patients’ dermatologic concerns.
With the onset of global pandemics and the massive shift to teledermatology, the unifying platform provides an opportunity to create a standardized and optimized virtual visit. To date, the prevalence of the different types of electronic medical records used in large academic practices has not been well studied. Larger, more comprehensive studies as well as guidelines to optimize the practice of teledermatology are needed as we continue improve digital dermatologic care.
DISCLOSURES
The authors have no relevant conflicts of interest to report.
REFERENCES
1. Yim KM, Florek AG, Oh DH, McKoy K, Armstrong AW. Telemedicine and e-Health. 2018;24:691-697. doi:http://doi.org/10.1089/tmj.2017.0253
2. Moore K. “Coronavirus (COVID-19): New Telehealth Rules and Procedure Codes for Testing.” FPM, American Academy of Family Physicians, 10 Mar. 2020, www.aafp.org/journals/fpm/blogs/gettingpaid/entry/coronavirus_testing_ telehealth.html.
3. “Fact Sheet Medicare Telemedicine Health Care Provider Fact Sheet.” CMS, 17 Mar. 2020, www.cms.gov/newsroom/fact-sheets/medicare-telemedicine- health-care-provider-fact-sheet.4.
4. “Choosing the Right Telehealth Platform.” American Academy of Dermatology, 9 Apr. 2020, www.aad.org/member/practice/telederm/vendors.
5. Mack, Heather. “Enterprise Video Conferencing Company Zoom Teams up with Epic to Launch Configurable Telehealth Platform.” MobiHealthNews, 20 Apr. 2017, www.mobihealthnews.com/content/enterprise-video-conferencing- company-zoom-teams-epic-launch-configurable-telehealth.
2. Moore K. “Coronavirus (COVID-19): New Telehealth Rules and Procedure Codes for Testing.” FPM, American Academy of Family Physicians, 10 Mar. 2020, www.aafp.org/journals/fpm/blogs/gettingpaid/entry/coronavirus_testing_ telehealth.html.
3. “Fact Sheet Medicare Telemedicine Health Care Provider Fact Sheet.” CMS, 17 Mar. 2020, www.cms.gov/newsroom/fact-sheets/medicare-telemedicine- health-care-provider-fact-sheet.4.
4. “Choosing the Right Telehealth Platform.” American Academy of Dermatology, 9 Apr. 2020, www.aad.org/member/practice/telederm/vendors.
5. Mack, Heather. “Enterprise Video Conferencing Company Zoom Teams up with Epic to Launch Configurable Telehealth Platform.” MobiHealthNews, 20 Apr. 2017, www.mobihealthnews.com/content/enterprise-video-conferencing- company-zoom-teams-epic-launch-configurable-telehealth.
AUTHOR CORRESPONDENCE
Michael Abrouk MD [email protected]
