@article{32277,
  keywords = {Cooperative Behavior, Demography, Dermatology, Humans, Models, Theoretical, Motivation, Practice Patterns, Physicians', Reimbursement Mechanisms, Telemedicine, United States},
  author = {Armstrong A and Kwong M and Ledo L and Nesbitt TS and Shewry S},
  title = {Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists.},
  abstract = {<p><strong>BACKGROUND: </strong>Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied.</p>

<p><strong>METHODS: </strong>The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California.</p>

<p><strong>RESULTS: </strong>Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers.</p>

<p><strong>CONCLUSION: </strong>Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.</p>
},
  year = {2011},
  journal = {PloS one},
  volume = {6},
  pages = {e28687},
  issn = {1932-6203},
  url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237480/pdf/pone.0028687.pdf},
  doi = {10.1371/journal.pone.0028687},
  language = {eng},
}