excellence in dermatology™az9194.vo.msecnd.net/pdfs/100903/1100.01.pdf · 2010. 10. 5. · cell...
TRANSCRIPT
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Excellence in Dermatology™
William James, M.D., FAAD
President, AAD
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Mobile Teledermatology
• Using mobile phones with built-in cameras and customized software to provide dermatologic services at a distance
• Ebner et al: Demonstrated no statistically significant difference between diagnosis resulting from face-to-face evaluation vs. mobile phone Teledermatology
• Patient acceptance excellent
Ebner C, et al. J Telemed Telecare. 2008;14(1):2-7.
Capture Image & Symptoms
Convey Diagnosis & Treatment Advice
Transmit Image & Symptoms
Transmit Diagnosis & Treatment Advice
Click-Health-WorkerPatient
Transmit Image & Symptoms
Provide Diagnosis & Treatment Advice
Remote doctors
1 2 3
6 5 4
Cell Phone -
Internet
Interface
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Teledermatology in Developing World
• Standard Internet-based teledermatology
– Urban centers in Africa
– Latin America
• Mobile teledermatology
– Urban and rural sub-Saharan Africa
– Egypt
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African
Teledermatology Sites
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africa.telederm.org
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Consultations
• Since launch of the africa.telederm.org program, more than 700 consults from 12 countries have been completed– Botswana, Burkina Faso, Eritrea, Kenya, Liberia,
Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda
• Received, processed, and diagnosed approximately 60 conditions via skin biopsy
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Telemedicine & Residents in Botswana
“Training in Botswana was an
inspiring experience that profoundly
enriched my life.” --Jennifer Tan-Billet, MD, Harvard Medical School,
2010 Resident International Grant Recipient
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http://latinoamerica.telederm.org
Expansion to Spanish-Speaking Countries
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UPenn Expansion in Philadelphia
• For uninsured or underinsured patients in
Philadelphia with limited access to specialty
care
– Sayre Clinic in West Philadelphia
– Lax Center in Center City Philadelphia
• Mobile telemedicine: time efficient, no need for
Internet connection/computers, security of
equipment
• Pilot program started in Aug 2009
• 75 consults successfully transmitted to date
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Community Health Centers Specialist Consults
Consult Answer
Discoid Lupus
Erythematosus
U Penn’s Mobile Teledermatology Work Flow
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AAD Mobile Teledermatology Pilot
• Provide dermatology specialty consultation to uninsured
and Medicaid patients seen in clinics
• Address need to expand access to dermatology
specialty care while tapping volunteerism spirit of
dermatologists
• Using mobile phones for store-and-forward images with
Web portal access by clinics and dermatologist
volunteers
• Involving 22 dermatologist volunteers
• Serving 14 clinics with 26 locations (in 6 states)
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AAD Mobile Teledermatology Process
Patient with
skin
condition
visits clinic
Clinic
GP/nurse
records and
sends
patient case
via mobile
phone
Remote
dermatologist
reviews and
consults on
case via
website
Clinic
GP/nurse
provides
necessary
treatment,
referral or
follow-up
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Device Overview: ClickDerm on Android
Home Screen
ClickDerm for AAD
Telederm Program
Power On/Off: hold for 5
seconds
Back Button: use anytime
to exit current screen
Menu Button: press to
unlock phone and awake
phone from sleep mode
Home Button: use
anytime to Home Screen
(this screen)
Gmail for notifications
Call Button: use to make
calls during emergency if
voice plan is activated
GoogleChat for
ClickSupport
Web browser for Internet
and case viewing
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Clinician Adds New Patient
Enter patient
account number
Add New Patient – enables request for
consult for the newly added patient
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Clinician Completes Questionnaire
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Clinician Takes Pictures, Submits Case
Press to take pictures,
as many as needed
Press when finished
IMPORTANT:
•Use the photo button on the application screen.
•Press and hold the button to focus image. You
should hear a beep sound
•DO NOT change phone or keyboard position
until thumbnail of image appears.
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Notification of Cases via email
Email notification to
consulting
dermatologist of a new
case awaiting consultClickSupport is
available on gchat
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Remote Dermatologist Accesses Website
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Dermatologist Selects Case
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Dermatologist Reviews Case
Click to enlarge
image
Time to answer case: Once the
case link is clicked, a response
should be entered within 24 hrs
Case owner – no other
doctor sees this case
in their queue
Name of clinician who submitted
request -will appear in format
[gp.lastname,fi,], e.g. gp.johnson.mi
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Clinician Receives Notification About Consult
Email notification
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Clinician Can Save/Print .pdf for EMR
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Challenges
• Diverse clinic practice arrangements
– Ensuring custody of phones and patient information
• Establishing relationships among various entities:
– AAD
– Application vendors
– Dermatologist volunteers
– Clinics
– Patients
• Ensuring appropriate handling of sensitive, but technically
not personal health information (PHI)
• Large geographic area (US and parts of Canada)
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Successes
• Many communities have high numbers of needy
patients and primary care physicians who are
enthusiastic about possibilities
• Wonderful team of selfless, committed
volunteers and hard-working staff supporting this
effort
• Technology capable of supporting a larger trial
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AAD Teledermatology Pilot Timeline
• Tested upgraded mobile phone applicationJuly ‘10
• Conducting on-site training for clinics, dermatologist volunteersAug/Sept ‘10
• Review launch and develop upgrades to applicationOctober ‘10
• Present initial evaluation at AAD Board of Directors meetingFebruary ‘11
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Dermatology in Action
• Academy strategic initiative on volunteerism
• Opportunities and encouragement to give
back:
– Academy programs
– Resources on volunteerism
– Donating supplies/Funding support
– Recognition for volunteer efforts
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Dermatology in Action
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Total Volunteer Hours
• Volunteers reporting hours: 1,213– Gold: 276
– Silver: 187
– Bronze: 411
• Total Hours Reported: 877,694
• Total Dollar Value: $98,014,698
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Dermatology in Action