"Store and forward" telemedicine making a comeback
A dermatology practice in Kentucky is trialling "store and forward" telemedicine technology for select patients with chronic skin conditions. It claims the service, albeit currently offered free, as the state's medical insurance does not cover the telehealth offering, has probably improved the practice's efficiency rather than acted as a financial drain. Patients can take photos of skin conditions and send them securely to their doctor via a mobile and web app where the telemedicine module combines the images and medical notes within Modernizing Medicine's electronic health record platform. One of the doctors said the service is evolving and could be charged for in the future.

The focus in telemedicine in recent years has seemed to be on live video consultations, but don’t dismiss store-and-forward technology just yet, even for office-based physicians. And don’t dismiss telemedicine even in the absence of reimbursement.

Since late 2015, Dermatology Associates of Northern Kentucky, a three-physician practice in Florence, Kentucky, has been using the telehealth feature in its electronic health record, the Electronic Medical Assistant EHR platform from Modernizing Medicine. The Boca Raton, Florida-based vendor makes speciality-specific EHRs and practice management systems and expanded into telemedicine nearly a year ago.

A consumer-facing mobile and Web app allows patients to take photos of skin conditions and send the images to their physicians securely. It’s not live, but rather store-and-forward technology. “In some ways, this works better for us,” said one of the dermatologists, Dr. Susan Bushelman.

“Our specialty, of course, is very visual,” Bushelman said. And the telemedicine module integrates the images, physician notes and related communications into the ModMed EHR.

Dermatology Associates only offers the service to select groups of established patients, mostly for chronic skin conditions like psoriasis and acne and for those undergoing treatment for skin cancer. “This offers us the opportunity to evaluate them in between visits,” Bushelman said.

The technology may also be good for people who, say, get poison ivy on vacation, Bushelman surmised. “We’re still sort of evolving,” she explained.

Remarkably, the practice makes no money by offering telehealth. “This particular interaction is not covered by insurance in Kentucky,” Bushelman noted. Dermatology Associates is not charging patients at the moment, but the doctors haven’t ruled that out in the future.

It’s not a complete financial loss, though. In fact, it probably makes the practice more efficient. “The telehealth option helps us expand capacity and helps the doctors maximize their time,” Bushelman said. They can spend a few minutes looking at a saved online consultation between in-person visits, especially if there is a no-show.

Bushelman said the practice is adding a fourth physician later this summer. At that point, every exam room will be filled, so efficiency will become imperative.

Photo: Modernizing Medicine