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7/7/21
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Pediatric TeledermatologyUpdate
Patrick McMahon, MDChildren’s Hospital of Philadelphia
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Disclosures
No Relevant Disclosures
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Overview
Ø Review of TD modalities at CHOP: Ø Why we use itØ Current offeringsØ What we have learned
Ø What are SPD members saying?ØWhat worksØWhat needs work
ØWell Rounded Pediatric Teledermatology:ØEducateØOptimizeØReach OutØTailor
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Longer Wait = More No-Shows
4R² = 0.7495
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0. 1
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0- 30 31- 60 61- 90 91- 120 121- 150 >150
Frac
tion
of c
ompl
eted
app
oint
men
ts
Wait time length (days)
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Longer Wait = More Touchpoints
5R² = 0.4807
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0. 1
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0- 30 31- 60 61- 90 91- 120 121- 150 >150
Aver
age
num
ber o
f tou
chpo
ints
pe
r pat
ient
Wait time length (days)
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Current Teledermatology Services(>9000 visits completed)
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1. Acne Express (E-Visits): store-and-forward, provider-to-patientPayment Method: Out-of-pocket $50 per consultNearly 1500 cases completed since 201865K miles saved driving
2. E-Consults: store-and-forward, provider-to-providerPayment Method: Funded through chair’s initiative grant
>300 cases completed since Spring 20209K miles saved driving
3. Video Visits: live-interactive, provider-to-patientPayment Method: Billed to insurance
>7500 visits completed since Spring 2020
Store-an
d-Fo
rward
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7/7/21
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Acne Express
Acne Express Details: • Must have EMR portal access• Patients: 8 years-17 years old• Must be the proxy account (not
the child)• Not for emergencies• Patient must be in NJ or PA
• Turnaround time within 2 business days (average 7 hrs)• Response sent to PCP & Proxy• Consult is $50 via credit card in
the app
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Dermatology E-Consults with West Philadelphia CHOP Primary Care
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E-Consult Data In-Person Visit Com parator
Average turnaround time for patient
families <48 Hours
4-6 m onths:Time off from work
Time off from school Travel Tim e
Wait Time Actual Visit Time
Average time per case for Derm atologist 7 M inutes 15 M inutes
Time per case for PCP 2-5 M inutes 1-2 minutes to submit expedited request
Patient Survey:
82% of patient/families agreed that they would
recommend the service to their friends & family
PCP Survey100% PCP’s would recommend this others
96% said they were able to address concerns of patients
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Derm E-Consult Overview• Dermatologists are helping PCP’s to: • expand differential diagnoses• recommend treatment options• providing reassurance• triaging patients to in-person consultations
• Top Diagnoses: Rash, Skin lesions, Hemangiomas
• Help identifying less common conditions: • Fox-Fordyce disease• Inverse psoriasis• Erythema ab igne
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Society of Pediatric Dermatology Member Survey
“How has TD positively impacted your practice over
the past year?”
• 98 responses• Not specific for one modality
of Teledermatology
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10
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50
60
70
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Non e Imp rov edd isp ari ties
Acce ss forlow res ou rce
Acce ss forNPV
C on ven ien ce Acce ss forfol low u p
Sa fe du ringC OVID
Positive Impacts of TD
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Society of Pediatric Dermatology Member Survey
“What is the most fundamental change needed
for successful delivery of pediatric TD?”
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5
10
15
20
25
30
35
40
Su pp o rt fro mDep t/Pra ctice
R egu lato ry Ch an ge s Imp rov ed T ech Fa ir re im bu rsem en t
Most Important Change Needed
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Seeing full faces without masks!
Easy for isotretinoin follow up
Seeing family pets!
What members said went well...
Easy for med refills
Safer during COVID
Good for quick diagnoses
Patients can show us the creams they are usingMore frequent follow ups
Saves time for families, less driving Kids miss less school
No commuting to work
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7/7/21
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Blurry photos or no photos
Poor video quality
What members said were “ugh”...
Lack of rapport
Sitting in one place
Eye strain! Wasting time finding patient or parent
Limited physical exam: No palpation, no dermatoscope
Encounter not taken seriously by patient
Lack of support teeing up visits
Worsened disparities in healthcare, digital literacy
Harder for non-English speaking patients
Poor connectivity/WiFi
Misdiagnoses
Harder to counsel patients
Unclear reimbursement
Hard for patients to navigate different platforms
Unable to swab, freeze, biopsy
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The Multi-Taskers & Hiding Children
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A Well Rounded Approach
Educate Optimize
TailorReach
Out
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www.pedsderm.net
EDUCATE
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7/7/21
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Educational initiative• Digital CME modules based on submitted cases
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OPTIMIZE
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REACH OUT
Health Insurance Disparities
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Video Visits
82%
18%
70%
30%
E-Visits
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Minimizing Disparities
E-Consults are facilitated by the referring providers and therefore minimize inequities in care
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7/7/21
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Tailoring Teledermatology for the Future
ØSupport for pediatric dermatologistsØ Protected time to develop, research and optimize servicesØ ReimbursementØ Clinical support to tee up visits & ensure photos are submitted and sufficientØ Allow for work-from-home and flexible scheduling
ØClarity for familiesØ Clear “menu” of optionsØ Set expectationØ Simple step-by-step instructions
ØMatching diagnoses and family preference with the right modality Ø Offer patients with acne a store-and-forward follow upØ Video visits for follow up patients who are unlikely to need procedures (eg. AD, vitiligo)Ø E-Consult services for lower resource settings to minimize disparities
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Thank You!
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