Tele-Dermatology During COVID-19

My experience with tele-dermatology has been a learning experience and a teaching opportunity in more ways than one. Given the pandemic, states with higher populations, such as my home state of Florida, have issued executive orders postponing elective and routine visits or procedures, and are encouraging all physicians to focus their efforts on the current situation, along with patients in urgent need. As such, there has been a nationwide shift for dermatologists to care for patients with routine issues through telemedicine.

What is telemedicine?

Telemedicine platforms allow patients to contact clinicians for care, advice, patient education, monitoring and decisions for future or possible intervention, and if even has the capability to conduct hospital admissions remotely, although I conduct very few. For dermatologists or other specialists who conduct mostly elective visits and heavily rely on visual assessments, telemedicine has become highly valuable tool.

The equipment needed to establish tele-dermatology in your practice includes a smartphone, tablet or widescreen computer monitor as well as internet connection. For my tele-dermatology visits I use Google Voice for telephone calls, and GoogleDuo for virtual/video calls. I also have remote access to our EMR and pull up the patient’s chart to reference while addressing their needs. While non-HIPAA compliant sources like Facetime and Facebook messenger can be used during the emergency period, it is important to transition to HIPAA-compliant platforms as soon as possible.

My Experience Starting Telemedicine

In our hospital-based practice at the Cleveland Clinic, we have gradually incorporated features of telemedicine with the MyChart platform and phone app in sync with EPIC. Through MyChart, my patients can message me directly, request refills, view critical results and view or respond to letters.

As a dermatologist who places high importance on organization, I highly encourage patients to use MyChart. It’s free to download, saves time and allows them to keep on top of important aspects of their health without causing significant obstacles or delays. I am also particularly fond of this app as a patient myself and use it for my own medical needs and to communicate with my own providers. Direct communication between doctors and patients through telecommunication systems such as MyChart work in sync with the electronic medical records and avoid miscommunications that could happen when delivering phone messages and voicemails. This allows patients to write out their concerns without altering or changing the message, minimizing these types of mistakes.

Licensing Requirements for Telemedicine

Using tele-dermatology for patients is permitted as long as you are practicing within the same state as your medical license. However, individual state laws vary regarding their definition of providing telemedicine services during emergency declarations. Some states, such as California and New York, have issued calls to reactivate or reinstate retired physicians to assist with COVID-19 efforts.

As a temporary measure, the Centers for Medicare and Medicaid (CMS) has waived licensing requirements for treating Medicare patients in a different state from your medical license; however, you should always check for additional guidance from the state your patient lives in.

It is also important to check with your malpractice carrier before starting telemedicine. Many states have declared public health emergencies and are temporarily waiving licensing requirements or creating additional licensure pathways in response to COVID-19.

As a physician, you can see Medicare patients you’ve not previously seen because of the CARES Act. This implementation is unique to the COVID-19 crisis for telehealth interactions to qualify for this waiver. While individual patient benefits should be verified, many private insurers have also adopted a similar measure to CMS to permit use of tele-dermatology services, at least on a temporary basis.

The government has significantly relaxed telemedicine regulations during the pandemic so that the doctor-patient relationship and medical care can continue virtually. Many insurance companies and the CMS have also followed suit and are currently processing claims. For additional guidance during this process, it is best to seek clarification through your designated MAC (Medicare Administrative Contractor).

NEXT: Limitations & Future Directions of Telemedicine