encounter, depending on the
copay. Time and cost reductions
are becoming apparent, and
patients are increasingly incentivized to use a telemedicine
platform. Because large copays
are creating large financial obligations, patients are becoming
cost-conscious when selecting
their healthcare options.
In 2004, a study was done to
understand how patients perceive
the notion of using telemedicine.
Researchers found that patients
were accepting of telemedicine
but had reservations about the
accuracy of their assessment. 18
Ten years later, patient attitudes
grew to favor complex wound surveillance using telemedicine.
However, an important factor in maximizing patient satisfaction and outcomes was the patient’s comfort level using the
technology and their level of training in it. 15
Patients are becoming accepting toward telemedicine
programs, but individual preferences will inevitably vary.
There seems to be a generational divide in expectations for
telemedicine and healthcare delivery. Nearly 60% of millennials support using telehealth platforms, and 71% prefer their
physicians’ use of a mobile application. 19 Telehealth support is
highest in millennials and lowest in baby boomers.
For all healthcare providers, it is evident that technology
will increasingly supplement and streamline medical practice.
While healthcare systems increasingly invest in transitional
and post-operative care, it is also important to determine best
practices for telemedicine adoption and use in wound care by
surgeons and their patients. 20
Proving Its Worth
At the Cleveland Clinic Foundation (CCF), we began implement-
ing our teledermatology program in 2014. It is the most recent
implementation of 10 patient access portals into the Cleveland
Clinic system (see Figure 1). In 2017, nearly two-thirds of CCF’s
dermatologists are active in teledermatology. Our average CCF
dermatology provider has approximately five telehealth visits
per month. As of this October, Cleveland Clinic Express Care
Centers have completed more than 1,000 “eConsults.”
Cleveland Clinic’s Express Care Clinics, which are staffed
primarily with nurse practitioners and physician assistants,
use secure store-and-forward teledermatology to con-
duct specialty consults. After testing store-and-forward
and synchronous video programs, store-and-forward visits
were deemed ideal as they maximized healthcare provider
efficiency and quality. Patient photos and relevant clinical
information are examined by a dermatology staff member.
They then determine if the treatment plan outlined by the
internal medicine provider was reasonable and an onsite
dermatology appointment could be deferred. The dermatology provider can also decide if a dermatology appointment
is required for further evaluation and treatment. Under this
system, fewer than one-third of consults required an onsite
Since the start of Cleveland Clinic’s teledermatology consult
program, we have found that care costs are 63% lower upon
utilizing Express Care and teledermatology consults when
compared to one dermatology visit. Through our four programs
(eVisit, Express Care online, TeleOpinion, and Post-Op Plastic
Surgery), our teledermatology visits quadrupled in volume
between November 2016 and February 2017. Having multiple
points of entry into the telemedicine program allows us to
reach more patients with distance health. Cleveland Clinic’s
Dermatology and Plastic Surgery Institute currently ranks
second among Cleveland Clinic institutes for the most total
distance health activity per month.
Building on Success
Our future work involves incorporating this technology in
other clinical situations. We are expanding the use of teledermatology into pediatric dermatology cases in our Express
Care Clinics and other satellite inpatient facilities. We are
collaborating with Cleveland Clinic’s Breast Cancer Program
and Taussig Cancer Institute to offer breast reconstruction
consults and monitoring.
Clinic Dermatology and