7/7/21

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Pediatric TeledermatologyUpdate

Patrick McMahon, MDChildren’s Hospital of Philadelphia

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Disclosures

No Relevant Disclosures

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Overview

Ø Review of TD modalities at CHOP: Ø Why we use itØ Current offeringsØ What we have learned

Ø What are SPD members saying?ØWhat worksØWhat needs work

ØWell Rounded Pediatric Teledermatology:ØEducateØOptimizeØReach OutØTailor

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Longer Wait = More No-Shows

4R² = 0.7495

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0- 30 31- 60 61- 90 91- 120 121- 150 >150

Frac

tion

of c

ompl

eted

app

oint

men

ts

Wait time length (days)

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Longer Wait = More Touchpoints

5R² = 0.4807

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0- 30 31- 60 61- 90 91- 120 121- 150 >150

Aver

age

num

ber o

f tou

chpo

ints

pe

r pat

ient

Wait time length (days)

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Current Teledermatology Services(>9000 visits completed)

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1. Acne Express (E-Visits): store-and-forward, provider-to-patientPayment Method: Out-of-pocket $50 per consultNearly 1500 cases completed since 201865K miles saved driving

2. E-Consults: store-and-forward, provider-to-providerPayment Method: Funded through chair’s initiative grant

>300 cases completed since Spring 20209K miles saved driving

3. Video Visits: live-interactive, provider-to-patientPayment Method: Billed to insurance

>7500 visits completed since Spring 2020

Store-an

d-Fo

rward

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Acne Express

Acne Express Details: • Must have EMR portal access• Patients: 8 years-17 years old• Must be the proxy account (not

the child)• Not for emergencies• Patient must be in NJ or PA

• Turnaround time within 2 business days (average 7 hrs)• Response sent to PCP & Proxy• Consult is $50 via credit card in

the app

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Dermatology E-Consults with West Philadelphia CHOP Primary Care

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E-Consult Data In-Person Visit Com parator

Average turnaround time for patient

families <48 Hours

4-6 m onths:Time off from work

Time off from school Travel Tim e

Wait Time Actual Visit Time

Average time per case for Derm atologist 7 M inutes 15 M inutes

Time per case for PCP 2-5 M inutes 1-2 minutes to submit expedited request

Patient Survey:

82% of patient/families agreed that they would

recommend the service to their friends & family

PCP Survey100% PCP’s would recommend this others

96% said they were able to address concerns of patients

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Derm E-Consult Overview• Dermatologists are helping PCP’s to: • expand differential diagnoses• recommend treatment options• providing reassurance• triaging patients to in-person consultations

• Top Diagnoses: Rash, Skin lesions, Hemangiomas

• Help identifying less common conditions: • Fox-Fordyce disease• Inverse psoriasis• Erythema ab igne

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Society of Pediatric Dermatology Member Survey

“How has TD positively impacted your practice over

the past year?”

• 98 responses• Not specific for one modality

of Teledermatology

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Non e Imp rov edd isp ari ties

Acce ss forlow res ou rce

Acce ss forNPV

C on ven ien ce Acce ss forfol low u p

Sa fe du ringC OVID

Positive Impacts of TD

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Society of Pediatric Dermatology Member Survey

“What is the most fundamental change needed

for successful delivery of pediatric TD?”

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Su pp o rt fro mDep t/Pra ctice

R egu lato ry Ch an ge s Imp rov ed T ech Fa ir re im bu rsem en t

Most Important Change Needed

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Seeing full faces without masks!

Easy for isotretinoin follow up

Seeing family pets!

What members said went well...

Easy for med refills

Safer during COVID

Good for quick diagnoses

Patients can show us the creams they are usingMore frequent follow ups

Saves time for families, less driving Kids miss less school

No commuting to work

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Blurry photos or no photos

Poor video quality

What members said were “ugh”...

Lack of rapport

Sitting in one place

Eye strain! Wasting time finding patient or parent

Limited physical exam: No palpation, no dermatoscope

Encounter not taken seriously by patient

Lack of support teeing up visits

Worsened disparities in healthcare, digital literacy

Harder for non-English speaking patients

Poor connectivity/WiFi

Misdiagnoses

Harder to counsel patients

Unclear reimbursement

Hard for patients to navigate different platforms

Unable to swab, freeze, biopsy

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The Multi-Taskers & Hiding Children

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A Well Rounded Approach

Educate Optimize

TailorReach

Out

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www.pedsderm.net

EDUCATE

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Educational initiative• Digital CME modules based on submitted cases

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OPTIMIZE

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REACH OUT

Health Insurance Disparities

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Video Visits

82%

18%

70%

30%

E-Visits

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Minimizing Disparities

E-Consults are facilitated by the referring providers and therefore minimize inequities in care

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7/7/21

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Tailoring Teledermatology for the Future

ØSupport for pediatric dermatologistsØ Protected time to develop, research and optimize servicesØ ReimbursementØ Clinical support to tee up visits & ensure photos are submitted and sufficientØ Allow for work-from-home and flexible scheduling

ØClarity for familiesØ Clear “menu” of optionsØ Set expectationØ Simple step-by-step instructions

ØMatching diagnoses and family preference with the right modality Ø Offer patients with acne a store-and-forward follow upØ Video visits for follow up patients who are unlikely to need procedures (eg. AD, vitiligo)Ø E-Consult services for lower resource settings to minimize disparities

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Thank You!

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