Telemedicina en Dermatología. Opciones en consulta pública y privada. Situación en diferentes Comunidades Autónomas. Posibilidades y desafíos. ___ #DERMAeSalud | AIES eSalud & Stiefel GSK Curso de formación en Nuevas Tecnologías de la Información y Comunicación (TICs) en la consulta de Dermatología. --- · Organiza: Asociación de Investigadores en eSalud (AIES); http://aiesalud.com · Patrocina: Stiefel, a GSK Company; http://www.stiefel.es/

3. 19:30h | TELEDERMATOLOGÍA
Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada.
Posibilidades y desafíos.
Dr Guillermo Romero Aguilera
Servicio de Dermatología
Hospital General Universitario de Ciudad Real
SESCAM

4. 19:30h | TELEDERMATOLOGÍA
Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada.
Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos
2. Situación en CCAA
3. Opciones privadas
4. Posibilidades y desafíos
SESCAM

5. 19:30h | TELEDERMATOLOGÍA
Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada.
Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos
2. Situación en CCAA
3. Opciones privadas
4. Posibilidades y desafíos
SESCAM

7. Teledermatology practice…………………

10. OBJETIVO / PROPÓSITO : DX-MANEJO O SEGUIMIENTO
SOLO TD
TDFTF
FTFTD

11. 1. PRIMARIA………PACIENTE  TD DERMATÓLOGO
2. SECUNDARIA….PACIENTE  MAP  TD  DERMATÓLOGO
3. TERCIARIA …….PACIENTE DERMATÓLOGO  TD DERMATÓLOGO
MODELOS
INTERACCIÓN EN TD
1
2
3

12. 19:30h | TELEDERMATOLOGÍA
Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada.
Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos
2. Situación en CCAA
3. Opciones privadas
4. Posibilidades y desafíos
SESCAM

13. Current Status of
Teledermatology in Spain
Dr Guillermo Romero , Dr Diego de Argila*
Departments of Dermatology
Hospital General Universitario de C. Real and Hospital
Universitario La Princesa* de Madrid
SESCAM

14. Introduction
• It’s no clear if teledermatology can be considered a
mature application 1.
• In fact it has been doubted his successful implantation
in some countries with a long tradition in TD 2.
• However, there are no longitudinal studies evaluating
its global development in a particular country.
1 Eminovic N et al Maturity of teledermatology evaluation research: a systematic literature review. Br J D 2007
2 English JS, Eedy DJ. Has teledermatology in the U.K. finally failed? Br J D 2007

15. Aims
• Current status of TD in Spain
– Organization
– Population & Pathology
– Adventages & Disadventages
• Development of Spanish TD in last 5 years
Objective: To analyze the degree of implementation of TD in Spain and the most important qualitative and quantitative characteristics of
functioning services. Theses include : organization, attended population, tecnology, teaching and researching, advantages and
disadventages.
We present the results of a comparative longitudinal study of two surveys conducted in 2009 and 2014 by the AEDV Image Group.

16. Methods
• Survey:
– Dr. Romero & Dr. de Argila. (Imaging group AEDV)
– Presentation letter
– National distribution  Abbvie
• Description  current results 2014
• Comparation with 2009 survey
The proposed access was different in the two surveys. In the first survey, in 2009, we have using a multi-pronged approach, we sought to identify
dermatologists practicing teledermatology in Spain. We contacted the members of AEDV Image Group to identify practicing teledermatologists in Spain. In
addition, we submitted a request via e-mail to dermatology department heads of the major hospitals in the country. We also demanded to the existing
teledermatologists to identify other practicing teledermatologists who might not have been captured with the above outreach efforts.
The approach in the second survey was holistic, integral, because using the Abbvit commercial net we could have contact with all dermatology services in the
country (267 services)

17. Index
• Organization aspects
• Technical aspects
• Teaching and researching
• Adventages & disadventages.

18. Methods
• Survey:
– Dr. Romero & Dr. de Argila. (Imaging group AEDV)
– Presentation letter
– National distribution  Abbvie
• Description  current results 2014
• Comparation with 2009 survey
The proposed access was different in the two surveys. In the first survey, in 2009, we have using a multi-pronged approach, we sought to identify
dermatologists practicing teledermatology in Spain. We contacted the members of AEDV Image Group to identify practicing teledermatologists in Spain. In
addition, we submitted a request via e-mail to dermatology department heads of the major hospitals in the country. We also demanded to the existing
teledermatologists to identify other practicing teledermatologists who might not have been captured with the above outreach efforts.
The approach in the second survey was holistic, integral, because using the Abbvit commercial net we could have contact with all dermatology services in the
country (267 services)

19. All 267 centers in Spain were accessed in
may 2014
•70 make TD (26%)
•45 filled a wide survey
•25 do not fill wide survey
64% agree to complete a wide survey ………
…and 36% don’t agree

20. Spanish centers with TD by autonomies 2009 vs 2014:
21 in 2009 / 70 in 2014
4/8
2/1
2/5
3/7
2/4
1/15
1/0
1/14
1/6
1/5 1/11/1
Increase >x3
Decrease in 2
Stable in 2
Increase in 9
Null in 5
1/2
0/1

21. Time service and survival over time
Time with TD
(years)
Centers
0-4 24
5-9 12
>10 5
5 With >10 years
Santiago 17
Don Benito 15
Badajoz 12
C-Real 10
Sevilla 10
17/21 active
Persist 14/17, 3 more Closed
2009
N= 41
RANGE 0.3 TO 17  MEDIAN 4.93
5
12
24
0
5
10
15
20
25
30
> 10 5-9 < 4
Years with TD

22. CUESTIONES TÉCNICASOrganization aspects

23. Tele-dermatologists / Hospital
N = 36 32%
37%
16%
5% 10%
Tele-Dermatologists
1
2
3
4
> 5
2009
18
43%
14
33%
10
24%
Dermatologist in Center
1-4
5-8
9-15
6
17%
15
41%
6
17%
3
8%
6
17%
Number of Teledermatologists
1
2
3
4
>5

24. Hours / Week
N = 43
12
56%
6
29%
2
10%
1
5%
0,5 a 2
2 a 5
5 a 10
>10
2009
16
39%
13
32%
8
19%
4
10%
0,5 a 2
2 a 5
5 a 10
>10

25. Time to do TD
8
38%
10
48%
3
14%
Specific time No specific time Other
2009
22
52%
13
31%
7
17%
With appointment list and
specific time for TD
No specific time “in breaks”
Other

26. Support with other labors in
Hospital
N = 42
9
21%
33
79%
Support Staff (nurses or other)
SI
NO

27. Data and Pictures
14
66%
2
10%
5
24%
DOCTOR NURSE MIXED
2009
34
79%
5
12%
4
9%
Who introduce the patient
data?
MEDICAL DOCTOR
NURSE
OTHER
33
70%
8
17%
6
13%
Who take the pictures?
MEDICAL DOCTOR
NURSE
OTHER

28. GP Centers
29% All kind, Near and far
centers, but only a %
-From 10 to 80%
-Media 45%
N=42
14%, only 6/42,
restricted to farest centers
22
52%
12
29%
6
14%
2
5%
Whole area
All kind but only a %
Only Farest
Specific types
52% Whole area,
without
restrictions

29. How far are the centers?
3
14%
10
47%
6
29%
2
10%
<30km 30-100km 100-1000km >1000km
2009
17
46%
16
43%
4
11%
Farest distance
<50 km
50-100km
>100 km
24
75%
5
16%
3
9%
Nearest distance
<25km
25-50km
>50km
N = 37

30. CUESTIONES TÉCNICASTechnical aspects

31. What kind of Tele-consultation?
14
67%
5
24%
2
9%
200935
83%
5
12%
2
5%
SF - TD
REAL TIME
HYBRID
2014

32. Tertiary TD
My Department makes
consultations to other
departments with TD
Other dermatologists make
consultations to my
Department with TD
0
0%
6
15%
35
85%
YES, USUALLY
SOMETIMES
NEVER
1
2% 5
12%
36
86%
YES, USUALLY
SOMETIMES
NEVER
N = 42

33. Pictures / Images
0
5
10
15
20
25
30
35
DIGITAL CAMERA
BRIDGE
DIGITAL CAMARA
HQ
DERMATOSCOPE MOBILE PHONE ECOGRAPH
CAPTURE DISPOSITIVES (GP)
DIGITAL CAMERA BRIDGE
DIGITAL CAMARA HQ
DERMATOSCOPE
MOBILE PHONE
ECOGRAPH
N = 41
(13 multiple)

34. Who design the TD system?
Public system:
Dermatologist & Informatics
HOSPITAL
WORKERS
(DERMATOLOGIST&
INFORMATICS), 23
IT COMPANY
ADAPTED , 12
IT COMPANY, 6
-IXEMAD
-SULIME
-BULL
-TELEFÓNICA
-CENTRICITY
-MED VIZER
- GENERAL ELECTRICS
Companies / Health Departments
- SERGAS
- DERCAM
- OSAKIDETZA
N = 41
Mixed: Software specifically
adapted
Commercial Software

35. DATA COLLECTION DESIGN:
TAKING PART DERMATOLOGIST
13
62%
8
38%
Si
No
2009
24
60%
16
40%
YES
NO

36. What kind of software?
14%
28%
58%
Is it possible to explode the data?
NO
SI
NS/NC
29%
27%
44%
Free space to reply
Predederminated and
mandatory items
mixed
What kind of software?
26%
14%60%
Is it available a diagnosis
codification?
NO
YES
NS/NC
N = 41

37. TD system is linked with
electronic clinical history?
4
19%
17
81%
Si No
200928, 64%
14, 32%
2, 4%
YES
NO
NA
N = 44

38. Satisfaction with TD system
(by dermatologists)
1
2%
7
17%
34
81%
NS/NC
0-5
5-10
MEAN 7.15

39. What kind of population and pathologies?

40. SPECIFIC CONDITIONS FOR TD
Population targeted.
9
42%
9
43%
2
10%
1
5%
General Disperse Remote Prisons
2009
42%
31%
8%
8%
11%
General population
Geographic dispersion
Remote Population
Prisons
Nursing Homes

41. Distribution of diseases
12
57%
8
38%
1
5%
General Oncology Esthetic
2009
34
61%
14
25%
3
5%
5
9%
General Dermatology
Oncology
Proffesional dermatosis
Other

42. Direct Appointment
in Surgery Room
17
40%
26
60%
YES
NO
N = 43

43. Teaching & Researching

44. Research & Publications
16
40%
24
60%
Research results
YES
NO
6
16%
31
84%
Publications
YES
NO

45. Tele-training to GPs
8
38%
7
33%
6
29%
13
62%
No yes Seminars Teleconsultation
20092009
7
17%
7
17%
13
31%
1
2%
14
33%
WITH TELECONSULTATION
SEMINARS AND MEETINGS
BOTH
OTHERS
NONE
N = 42

46. Patient Satisfaction Surveys
4
19%
17
81%
Yes
No
2009
8
20%
33
80%
YES
NO

47. Main problems to implement TD systems
2
10%
8
37%
4
19%
2
10%
5
24%
HIS Primary Care Gerency Other None
2009
6
13%
3
7%
18
40%
3
7%
7
15%
4
9%
4
9% MEDICAL GERENCY
APPOINTMENT SERVICE
(HIS)
PRIMARY CARE
PATIENTS
DERMATOLOGY
DEPARTMENT
TECHNOLOGY
OTHERS
N = 36 (8multiple)

48. Satisfaction with TD
(Score 0-10)
Average (2014): 6,9
Average (2009): 6,3

49. Adventages & Disadventages

50. Adventages (dermatologist point of view)
Score 0  10
Main advantages of using the system TD
(qualify of 0-10, with 0 being strongly disagree, 10 Total agreement)
7.66 7.64
8.29
7.85
7.60
6.90
6.60
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
IMPROVE
COMMUNICATION
WITH GP
SCREENING OF
COMMON
DISEASES
PRIORIZATION IN
ONCOLOGY
PRIORIZATION OF
EMERGENCIES
SAVING VISITS
AND PATIENTS
TRAVELS
IMPROVE GP
TRAINING
IMPROVE GLOBAL
PATIENT
MANAGEMENT

51. DISADVENTAGES (dermatologist point of view)
Main disadvantages or problems using the TD system  qualify of 0-10, with 0 being the
problem does not exist at all, 10 very serious and difficult problem to solve):
3.73
2.64
3.95
6.38
5.75
3.37
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
DIFFICULT
COORDINATION
WITH PRIMARY
CARE
LACK OF
DERMATOLOGISTS
COOPERATION
LACK OF GPs
COOPERATION
PICTURES WITH BAS
QUALITY
RISK OF MEDICAL
MISTAKE
TIME CONSUMING

52. Summary of results I:
Centers and organization.
• All Spain centers 267 were surveyed, 70 had TD (26.2%)
• Increase 21 to 70, x3 in 5 years (2009  2014)
• Progressive increase Time service: 59% <4a, 29% 5-9 a, 5 >10
años; Range 0.3-17 years, median 4.93y
• In 5 years 14/17 active centers survive from 2009, <20% have
been closed.
• In each serviceTD is a subunity, from 2009 there are an increase of
active dermatologists and TD hours by week.
• Only 20% with nurse participing, specific time for performance
increase from 38 to 52% in SC,

53. Summary of results II
Technology
• SFTD is the predominant technique and this primacy
continuous to increase (from 67 to 83%).
• 15% make Tele DSC, 13% use smart-phone, and 15% practice
tertiary TD.
• Software only 20% commercial no adapted, 60% design with
Dermatologist collaboration. Linked with e-HIS in 64% (only
19% in 2009);Codification <33%;
• Satisfaction with technology system 7.15 (mean) and only 20%
<5 (score 0-10)

54. • Attention to disperse/remote fall 53% in 2009 to 39% in 2014;
• Primary Care: only farest 15%, all type of centers 85%.
• More center are in Urban setting, 50% don’t assist any patient
>50km.
• Pathology: all type 60%, oncology 25%
• GP-Learning in 66%
Summary of results III
Objectives

55. Global satisfaction 6.3 in 2009 increase to 6.9 in 2014 (score 0-10)
>
Summary of results IV
Advantages & Disadvantages

56. 19:30h | TELEDERMATOLOGÍA
Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada.
Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos
2. Situación en CCAA
3. Opciones privadas
4. Posibilidades y desafíos
SESCAM

57. TD
PRIVADA

58. TD
PRIVADA

59. TD
PRIVADA

60. TD
PRIVADA

61. TD
PRIVADA

62. TD
PRIVADA
•Consentimiento.
•privacidad //https//
cifrado// claves //
•Quien remite paciente?.
•Hay seguimiento?.
•Seguro médico /
responsabilidad.
•Control de riesgos:
calidad fotos y seguridad
en dx.

63. 19:30h | TELEDERMATOLOGÍA
Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada.
Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos
2. Situación en CCAA
3. Opciones privadas
4. Posibilidades y desafíos  PREGUNTAS
SESCAM