Tell Us About Telehealth


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This was presented in session F5 at the Quality Forum 2014 by:

Cheryl Rivard
Coordinator, Patients as Partners
Vancouver Coastal Health

Brian Bootsman
Telehealth Systems Engineer/Architect
Vancouver Coastal Health

Wingfield Rehmus
Clinical Assistant Professor of Pediatrics
Member of the Teledermatology Steering Committee
Doctors of BC

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Tell Us About Telehealth

  1. 1. ConsultDerm BC Teledermatology Initiative Prepared by Dr. Shane Barclay, Sarah Stephanson, and Dr. Wingfield Rehmus
  2. 2. Teledermatology Initiative  The Shared Care Teledermatology initiative makes dermatological consults available for family physicians in urban, remote, and isolated communities in BC through easy to use digital technology and secure, confidential Internet access through ConsultDerm BC  The Shared Care Committee, a joint committee of Doctors of BC and the Ministry of Health works to improve health outcomes and the patient journey through the health care system 2
  3. 3. Why We Need Teledermatology? Front page - Vancouver Sun November 2013 : BC suffers shortage of dermatologists BC has estimated shortage of 24 dermatologists Only dermatologist in Northern Health Authority has retired Wait times for consults have doubled over previous years 3 * * * ** * ** * * *** * * * ** *
  4. 4. Teledermatology Options  Live Teleconsultation  Advantages  Communication with patient  Reimbursement for MD  Disadvantages  Costly equipment  Difficult scheduling  Store and Forward  Advantages  Better image quality  Empowering and educational for GP’s  Supports relationship between GP and patient  Disadvantages  Unable to make incidental diagnoses
  5. 5. Teledermatology Studies Found  The diagnosis and treatment plan made over the system is as effective and comparable to those made in person (90-95% accurate)  Many patients prefer teledermatology to live dermatology visits  Teledermatology is generally considered cost-effective  Decreased wait times leading to better outcomes  Fewer in-person visits  Less time off from work  In Alberta, ConsultDerm has reduced the average wait time to see a dermatologist from 104 days to < 3 days 5
  6. 6. What is ConsultDerm BC?  Web based program, free to patients and doctors, that allows doctors in BC to obtain a dermatological consultation in a timely fashion.  Uses ‘store and forward’ technology where the referring doctor takes pictures of dermatological cases, logs into the ConsultDerm BC site then downloads the patient history and pictures GOAL: Provide consult within 48 hours 6
  7. 7. What is ConsultDerm BC? cont’d  Utilizes a program developed by Dr. Jaggi Rao from the University of Alberta. It is a ‘not for profit’ program.  Dermatologists are reimbursed for their participation in the project on a per consult basis.  Now being used in Alberta, BC, NWT and PEI. 7
  8. 8. More About ConsultDerm BC  All dermatology consults tracked and answered  No consult is lost or delayed  Past consults are readily available  All physicians and nurse practitioners in BC have access  No specialized software needed  System interface is easy to use  The database is secure and confidential 8
  9. 9. How Does it Work?  Register with ConsultDerm – takes 5 minutes  Must be a BC College registered physician with an MSP number (family physician or specialist)  Using PC, Mac, iPhone/adroid, tablet etc, log into: 1 2 9
  10. 10. Request a Consult Through ConsultDerm  See patient in office, either ‘on the spot’ or pre-booked  Obtain consent – this can be a signed consent, or a verbal consent charted in your notes  Take history and pictures  Log into ConsultDerm  Submit the consult (includes pictures) 10
  11. 11. How it Works Once your referral is sent - an email alert goes to the Teledermatologist who then:  Logs into ConsultDerm  Reviews the images and history  Provides: 1. an impression; 2. a ‘note’ (educational component); 3. recommendation/management plan. Once the Teledermatologist has completed the consult, an email alert goes to the referring doctor who then:  logs into ConsultDerm  retrieves the consult  reviews results with the patient 11
  12. 12. Review Your Consult Results This information is the teledermatologist’s consult The information from here down is the information you provided for the consult 12
  13. 13. Print Your Consult Results Just like any other consult letter, it can be printed off and scanned into the patient’s chart 13
  14. 14. Review With Your Patient A copy of the consult letter, along with any patient handouts provided by the teledermatologist, may be given to your patient 14
  15. 15. Teledermatology in BC 2 prototype sites in BC: Salt Spring Island Central Okanagan, through a partnership with the Central Okanagan Division of Family Practice  Study by Drs Barclay and Cooper  95% strongly agreed or agreed that telederm was more convenient than going off-island (1 pt “neutral”)  100% comfortable with photographs being taken and sent to a secure website  73% confident that dermatologist could make accurate diagnosis (Other patients “neutral”)  86% satisfied (1 unsatisfied due to time delay)  86% prefer telederm to off-island face-to-face consultation 15
  16. 16. Teledermatology Impact - Quantitative Currently used by more than 450 BC family physicians and 9 Dermatologists: Dr Patrick Kenny  Dr Vincent Ho Dr Carmel Anderson  Dr Gabriele Weichert Dr Jaggi Rao  Dr Kevin Peter Dr Alistair McLeod  Dr Donald Jenkins Dr Wingfield Rehmus (pediatrics) More than 900 consults completed to date
  17. 17. Teledermatology Impact - Qualitative  “Rapid access to online Dermatology resulted in me being able to manage my patients and reduce patient anxiety regarding assessment and treatment.”  “This has been an excellent learning tool for me. I feel like I have a good understanding of dermatology after working in family practice for many years, but there are patient conditions that still stump me. I can see this being very helpful for new doctors as well.”  It only takes me about 5 minutes, using my iPhone, to take the picture and send it in.”
  18. 18. Teledermatology Impact - Qualitative  “I had this patient with atypical eczema and was comfortable with the assessment. But the patient and parent wanted a consult to the dermatologist. I sent the picture to ConsultDerm and had a response back the next day confirming my initial finding. The new 14076 patient conference fee code enabled me to phone the patient with results of which reduced their anxiety and avoided a follow-up visit.”  “I had this 14 year old patient with a keloid scar and was going to provide an injection in my office. Before the therapy I sent Dr Anderson a picture who confirmed the issue and recommended a dilutions schedule. This was hugely helpful as the recommended starting dose was much lower than I had expected. The first treatment worked so well, I didn’t see the patient again. Without access to online dermatology, this kid would have waited 6-9 months.”
  19. 19. Teledermatology – Next steps  Obtain MSP funding for store and forward teledermatology  Revisit options for long-term storage of images/consults  Add educational component with CME credit for GPs
  20. 20. For more information: Wingfield Rehmus Shane Barclay Sarah Stephanson Tristan Smith
  21. 21. For more information Shared Care Committee 115 - 1665 West Broadway Vancouver, BC V6J 5A4 Tel: 604 736-5551