02849nas a2200301   4500000000100000008004100001653002500042653001500067653001600082653001100098653002400109653001500133653003500148653002900183653001700212653001800229100001600247700001200263700001100275700001500286700001300301245011400314856007800428300001100506490000600517520201000523022001402533       2011                            d10aCooperative Behavior10aDemography10aDermatology10aHumans10aModels, Theoretical10aMotivation10aPractice Patterns, Physicians'10aReimbursement Mechanisms10aTelemedicine10aUnited States1 aArmstrong A1 aKwong M1 aLedo L1 aNesbitt TS1 aShewry S00aPractice models and challenges in teledermatology: a study of collective experiences from teledermatologists.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237480/pdf/pone.0028687.pdf  ae286870 v63 a<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>
  a1932-6203