By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    rollder skating exercise
    Is Roller Skating A Good Exercise For Runners’ Health?
    December 14, 2022
    complex carbs vs simple carbs
    Why Are Complex Carbs Better Than Simple Carbs?
    February 27, 2023
    Private Practice
    11 Ways To Modernize Your Private Practice
    May 17, 2023
    Latest News
    How Probate Planning Shapes the Future of Your Estate and Family Care
    July 17, 2025
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    FDA Approves “NoTouch” BreastScan Device
    March 7, 2012
    Do Republican Presidential Candidates Have any Good Ideas on Health Care?
    August 30, 2011
    Are Women Getting Crazier? Medco Seems to Think So
    March 21, 2012
    Latest News
    How IT and Marketing Teams Can Collaborate to Protect Patient Trust
    July 17, 2025
    How Health Choices and Legal Actions Intersect After an Injury
    July 17, 2025
    How communities and healthcare providers can address slip and fall injuries with legal awareness
    July 17, 2025
    Let Your Lawyer Handle the Work Before You Pay Medical Costs
    July 6, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Direct-to-Consumer Telemedicine: Has Its Time Come?
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > eHealth > Direct-to-Consumer Telemedicine: Has Its Time Come?
eHealth

Direct-to-Consumer Telemedicine: Has Its Time Come?

JosephKvedar
JosephKvedar
Share
10 Min Read
SHARE

It was 1999, and I was speaking at a prestigious academic center’s ‘Innovations in Dermatology’ symposium.  I presented work we had done on a web application that would allow a non-dermatologist (primary care doctor or other front-line provider) to upload images of a patient’s skin as well as some history.  Subsequently, a dermatologist could review both the history and the images and enter a diagnosis and recommendations on the same website.  My talk was greeted with intense scorn by one audience member (“You are cheapening our specia

It was 1999, and I was speaking at a prestigious academic center’s ‘Innovations in Dermatology’ symposium.  I presented work we had done on a web application that would allow a non-dermatologist (primary care doctor or other front-line provider) to upload images of a patient’s skin as well as some history.  Subsequently, a dermatologist could review both the history and the images and enter a diagnosis and recommendations on the same website.  My talk was greeted with intense scorn by one audience member (“You are cheapening our specialty,” he told me) and general lack of enthusiasm by most of the others.

Fast-forward to 2014.  Dermatologists share digital images via email and a number of social networks thousands of times a day.  If the specialty is cheapened, I can safely say it is not due to this activity.  So far, we’ve not created any ‘cutaneous radiologists’ which was another fear of nay sayers at the time.  In fact, the American Academy of Dermatology has an officially sponsored software application that members can use to provide volunteer teledermatology services to underserved clinics, and is planning on promoting this concept in the coming year. What a difference 15 years makes!

I use this story to set context for a thoughtful discussion on one of the most controversial telemedicine questions of our current time. Is it safe and effective care for providers to evaluate and prescribe for patients that they’ve never met face-to-face?

More Read

Why Information Therapy Has Become Even More Important Today
Diabetes and Oncology at Doctors 2.0 & You
Keeping Up With a Picture Perfect World for Healthcare Marketing
Patient Engagement: From Idea to Proof
Medtronic’s Doctor Centered Approach Helps Patients, Too

Join me in thinking through this question.

1.  Most health care requires authentic relationships.

You don’t have to go very far to find graphic stories about folks who form relationships online.  These relationships become quite ‘close,’ then the parties meet face-to-face and find that one or both was being highly deceptive with their online persona.  It seems safe to conclude that the possibility of fraud in online relationships is much higher than in person.  Most clinicians feel that forming a relationship with their patients is a core part of providing quality health care.  Until this authentication challenge is solved, it’s hard to imagine many health care interactions with new patients being conducted in an online environment.  Some of you may be thinking that ubiquitous, embedded videoconferencing solves this and certainly adds a great deal of value beyond text-based interactions.  But I don’t know if we can say applications like Skype and FaceTime are the complete answer.

2.  How do we define quality care in this new environment?

When you go to a hotel, you expect clean sheets and towels, a warm shower, a bed you can sleep in, and comfortable room temperature.  What are the same minimum quality requirements for an initial doctor’s visit?  As doctors, we’re taught that this includes a complete medical history and physical exam relevant to our specialty.  As a dermatologist, I am not expected to do a complete neurological exam (you should be thankful for that) but unless you decline, I am expected to do a complete skin exam, even if you come in for a 4 X 4 cm patch of poison ivy on your arm.  This is something that I really cannot do online, even with current state-of-the-art technologies.

The idea of allowing patients to upload images of body moles or facial acne for evaluation by providers they have not ever met gives many of my colleagues great consternation. (Even more controversial are image analysis scientists who are creating applications that can analyze these images without human intervention.  More on that phenomenon at a later date.)  My colleagues fret that a patient will send them an image of a mole that is benign, but ignore a mole that is an incipient melanoma.  To me, this seems less onerous than the authentication issue.  Patients are capable of managing their own risks when these risks are spelled out.  For example, it seems perfectly reasonable to alert an individual that she may be missing an important lesion if she chooses to submit an image over the Internet, rather than come in for a complete exam.  A closely related fear or objection is one of physician liability.  In this context, the doctor is not only afraid they will provide substandard care by not doing a complete physical exam, but that they may be held liable for that omission.  Once again, spelling out that a patient is taking accountability for those aspects of his care not addressed in an online interaction seems reasonable to me.  I think the liability concerns are overstated.

3.  Is the technology up to the task at hand?

There is not a general yes/no answer to this question.  It is medical problem specific.  The answers are in the realm of clinical research.  Taking you back again to the late ‘90s, we (and many others) did painstaking clinical studies to empirically test whether a set of digital images is of sufficient quality to be a diagnostic tool in lieu of an in person exam.  There now exists a body of literature that demonstrates this equivalency, with the possible exception of some pigmented lesions.  We also carefully examined the feasibility that patients could take their own, clinically accurate, facial images of acne. Are there other examples?  Can a psychiatrist do an initial evaluation of a patient via interactive video?  I am not up on this literature, but my guess is that it has been studied and the answer is yes.  There are probably a few other examples as well.

Where does this leave us in my logical analysis?  To provide a quality care experience online without having met the patient in person, I content that the following criteria would need to be met:

1.  Identify a medical problem that has a diagnostic data set, easily and reliably acquired by a consumer/patient.

2.  Assure that the patient is capable of understanding that the online interaction is problem specific and may carry risks, particularly for omission of care involving other health problems.

3.  Assure that the treatment decisions for the specific condition at hand are algorithmic and do not require an authentic relationship (i.e., the problem is transactional or of low emotional value to both provider and patient).

This is exactly what some folks have done with two fledgling companies, Direct Dermatology and DermatologistOnCall.

Direct Dermatology

 

DermatologistOnCall

They accept images of facial acne and if they are comfortable making a diagnosis, will prescribe a limited array of therapeutics for these patients.  Both are gaining some traction, indicating that there is consumer demand.  Interestingly, since acne images involve the face, it makes it much less likely that an individual can assume a fraudulent online personality.  And even if they decided to have their friend send in facial images what would be the point — to clandestinely procure a prescription for a topical antibiotic?  I’d say there is not much risk on the authentication side in this model.

Another interesting comparison is the rise of retail clinics. These were initially scorned by primary care providers, but consumers are drawn to the convenience.  The repertoire of problems is limited, as are the therapeutic options. Patients are made aware of these limitations and the associated risks.

Perhaps Direct Dermatology and DermatologistOnCall are the vanguard of a new set of medical services that are like retail clinics but delivered in an online environment.  I’ll watch their evolution with great interest.  And I think the risk of cheapening our specialty is low.

TAGGED:telemedicine
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
How IT and Marketing Teams Can Collaborate to Protect Patient Trust
Global Healthcare Policy & Law
July 17, 2025
paramedics in surgical gloves and masks
How Health Choices and Legal Actions Intersect After an Injury
Health care
July 16, 2025
a woman giving a key
How Probate Planning Shapes the Future of Your Estate and Family Care
Health
July 16, 2025
a woman with kinesio tapes on her back arm
How communities and healthcare providers can address slip and fall injuries with legal awareness
Health care
July 16, 2025

You Might also Like

HIPAA: Liability to Private Parties for Violations

November 18, 2014
eHealthMedical RecordsNewsTechnology

5 Worst Cyber Attacks of 2017 So Far

October 20, 2017
marketing to millennials
Social MediaTechnology

Medical Marketing to Millennials: Convenience is the New Currency

June 2, 2016

Telemonitoring: Why Wait?

January 17, 2014
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?