Improving quality of teledermatology visits: The Skin-Know-Implement-Next checklist

Telemedicine usage has increased significantly in the past year due to the COVID-19 pandemic. As reported by the Centers for Disease Control and Prevention, there was a 154% increase in telehealth visits during the last week of March 2020 compared to the same time in 2019.¹ As public health organizations maintain current social distancing guidelines, this platform can help overcome barriers in access to health care while minimizing the risk of exposure to COVID-19. This can be particularly helpful in dermatology, a field in which there is a high clinic volume and whose patients often require long-term use of immunomodulatory medications.²

The inherent visual nature of dermatology makes it a perfect fit for the practice of telemedicine. Teledermatology is usually practiced by either live, interactive videoconferencing, asynchronous store-and-forward technologies, or a hybrid. The American Academy of Dermatology has listed many benefits of teledermatology, including increasing access to expert care, delivering quality care at a lower cost, addressing maldistribution of subspecialists, facilitating patient compliance, and triaging medical problems.³ In addition, live/interactive teledermatology programs have demonstrated high levels of patient satisfaction due to decreased travel times, waiting times, and costs. Although teledermatology is well accepted by most dermatologists, it has drawbacks: some specific skin conditions and whole-body examinations are difficult to assess, and there are patient privacy concerns and challenges using the technology. Additionally, while physician reimbursement was increased during the COVID-19 pandemic, the future is not clear and depends on insurance company decisions.⁴

Technologically oriented care can pose challenges to both the patient and the provider. Technology's ability to “dehumanize” can lessen the empathic physician-patient relationship. Importantly, there are certain populations who face difficulties with video visits, including elderly, low-socioeconomic status individuals; people based in rural communities; and those with disabilities. These patients will need specialized guidance and extra attention before virtual visits. Even with thorough instructions to access care, patients may have trouble displaying lesions properly or run into technological barriers during the visit, which leads to workflow disruptions.² Nonetheless, it is the staff's responsibility to limit extrinsic variables that can limit workplace efficiency.

To our knowledge, there have not been any published, patient-oriented checklists written in easy-to-learn acronyms within the field of dermatology. Meanwhile, other fields have found similar previsit patient checklists to improve flow and optimize virtual visits based on observational evidence. A report on telemedicine in orthopedics emphasized proper camera positioning, audiovisual aids, and patient posture for successful tele-encounters.⁵ To enhance an accessible teledermatology system and overcome barriers to care, we have created a checklist that serves as a guide for patients (Fig 1 ). Our Skin-Know-Implement-Next checklist was formulated on the principle that the institution, the physician, and the patient are vital components to effective telemedicine. The Skin-Know-Implement-Next checklist provides a framework for an effective and efficient teledermatology visit through patient and staff education. Our checklist is concise yet comprehensive and is easily implementable. By creating actionable plans, we hope to overcome the high prevalence of inexperience with telecommunications and disabilities in vulnerable populations.

Fig 1.

Skin-Know-Implement-Next (SKIN) Checklist. This checklist provides patient education before, during, and after a teledermatology visit to facilitate a more efficient and effective appointment.

Conflicts of interest

Dr Mostow is an associate editor at Practiceupdate.com, Dermatology Channel. Authors Patel and Mal and Dr Patel have no conflicts of interest to declare.