Teledermatology revolutionizing rural care

A network of teledermatology links throughout Alaska is providing cost-effective, timely access to dermatologic care for indigenous peoples in the nation's most underserved and sprawling state, its designer reports.

Teledermatology programs organized by the Alaska Tribal Health System (ATHS) serve approximately 50,000 patients scattered throughout the state, reports John H. Bocachica, M.D., F.A.A.D., chief, dermatology and teledermatology at the Alaska Native Medical Center (ANMC) in Anchorage.

The ATHS is a large umbrella organization that serves the native population of rural Alaska by overseeing the ANMC, along with the Alaska Federal Health Care Access Network (AFHCAN) and the family practice-oriented Southcentral Foundation.

AFHCAN has deployed telemedicine solutions to more than 250 sites throughout Alaska. These sites employ a standard telehealth platform (called the AFHCAN cart) and are supported by 42 connected servers and a satellite-based IP network reaching nearly 200 sites, says Dr. Bocachica.

Since the statewide system debuted in 2002, it has facilitated close to 1,500 teledermatology consultations, he says. In this regard, Dr. Bocachica says Alaska presents a somewhat unique challenge: According to the AAD, the state includes just eight dermatologists serving a total population of nearly 630,000.

In such settings, he says, "The largest savings that telemedicine offers are in travel costs."

Preliminary AFHCAN data reveals that the availability of telemedicine prevents patients and their families from having to travel 37 percent of the time.

"By using telemedicine," he explains, "I can receive a high-resolution image of a patient provided by a physician. I can look at that, render an accurate diagnosis and send it back to him with my recommendations."

In other cases, providers including physician assistants, nurse practitioners and community health aides trained by the ANMC snap and send the images, Dr. Bocachica adds.

As opposed to real-time teledermatology consultations, the Alaskan system uses only store-and-forward techniques whereby Dr. Bocachica downloads and processes images during a designated 60- or 90-minute period daily.

By eliminating the need for a receptionist, nurse and waiting room, he says, "I can probably do about four times as many telemedicine consultations within the same time frame it takes me to see one live patient."

Dr. Bocachica says that psoriasis, eczema, viral exanthems, acne and contact dermatitis represent the most common skin problems he sees through telemedicine. Other complaints include a significant number of methicillin-resistant Staphylococcus aureus (MRSA) infections.

"The one lesion where I almost always ask to have the patient brought into Anchorage is a suspicious pigmented lesion. One would never want to sit on a potential melanoma," he adds.

Telemedicine also allows Dr. Bocachica to prescreen which patients he needs to see personally from those he doesn't. In early 2006 he implemented the requirement that prior to his accepting referrals from the field, he must see electronic images first.

Dr. Bocachica says that for telemedicine to work, one must involve the people it's designed to serve from the start. Because developers took this approach, he says practitioners have found that "Telemedicine, and in particular teledermatology, has absolutely revolutionized their practices." DT

Disclosure: Dr. Bocachica reports no financial interests relevant to this article.

Dr. Bocachica will speak on telemedicine today in WRK405 from 9 a.m. to noon.