Skip to main content

Overcoming Barriers to Implementation of Teledermatology in Rural America

  • Chapter
  • First Online:
Dermatology in Rural Settings

Abstract

Teledermatology, for all its promise, played only a minor role in the care of patients in the United States until the onset of the COVID-19 pandemic in the spring of 2020. Deregulation coupled with closure of clinical practices, except for the most urgent and emergent conditions, led to a tremendous surge in clinical care from a distance. Technical issues preventing efficient use of teledermatology were highlighted during this period. As the pandemic plays out, we are at a crossroads. Some form of regulation of telehealth will return and technical problems persist. Still, dermatologists have seen the benefits derived from teledermatology reaching patients who are otherwise unable to be seen in the office. It is the purpose of this chapter to review the barriers to routine use of telehealth and identify solutions to improve access to care in rural areas.

Obstacles are those frightful things you see when you take your eyes off your goals

—Henry Ford

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Perkins S, Cohen JM, Nelson CA, Bunick CG. Teledermatology in the era of COVID-19: experience of an academic department of dermatology. J Am Acad Dermatol. 2020 Jul;83(1):e43–4. https://doi.org/10.1016/j.jaad.2020.04.048.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Gupta R, Ibraheim MK, Doan HQ. Teledermatology in the wake of COVID-19: advantages and challenges to continued care. J Am Acad Dermatol. 2020;83(1):168–9. https://doi.org/10.1016/j.jaad.2020.04.080.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ahn CS, Allen MM, Davis SA, Huang KE, Fleischer AB Jr, Feldman SR. The National Ambulatory Medical Care Survey: a resource for understanding the outpatient dermatology treatment. J Dermatolog Treat. 2014;25(6):453–8. https://doi.org/10.3109/09546634.2014.858409.

    Article  PubMed  Google Scholar 

  4. Loane MA, Bloomer SE, Corbett R, Eedy DJ, Hicks N, Lottery HE, et al. A comparison of real-time and store-and-forward teledermatology: a cost-benefit study. Br J Dermatol. 2000;143(6):1241–7. https://doi.org/10.1046/j.1365-2133.2000.03895.x.

    Article  CAS  PubMed  Google Scholar 

  5. Black SM, Ali FR. Secure communication conduits during COVID-19 lockdown. Clin Exp Dermatol. 2020;45(6):748–9. https://doi.org/10.1111/ced.14244.

    Article  CAS  PubMed  Google Scholar 

  6. Manahan MN, Soyer HP, Loescher LJ, Horsham C, Vagenas D, Whiteman DC, et al. Br J Dermatol. 2015;172(4):1072–80. https://doi.org/10.1111/bjd.13550.

    Article  CAS  PubMed  Google Scholar 

  7. Gendreau JL, Gemelas J, Wang M, Capulong D, Lau C, Bratten DM, et al. Unimaged melanomas in store-and-forward teledermatology. Telemed J E Health. 2017;23(6):517–20. https://doi.org/10.1089/tmj.2016.0170.

    Article  PubMed  Google Scholar 

  8. van der Heijden JP, Thijssing L, Witkamp L, Spuls PI, de Keizer NF. Accuracy and reliability of teledermatoscopy with images taken by primary care providers during everyday practice. J Telemed Telecare. 2013;19(6):320–5. https://doi.org/10.1177/1357633X13503437.

    Article  PubMed  Google Scholar 

  9. Senel E, Sabancılar E, Mansuroğlu C, Demir E. A preliminary study of the contribution of telemicroscopy to the diagnosis and management of skin tumours in teledermatology. J Telemed Telecare. 2014;20(4):178–83. https://doi.org/10.1177/1357633X14533885.

    Article  PubMed  Google Scholar 

  10. Anderson D, Villagra VG, Coman E, Ahmed T, Porto A, Jepeal N, et al. Reduced cost of specialty care using electronic consultations for medicaid patients. Health Aff (Millwood). 2018;37(12):2031–6. https://doi.org/10.1377/hlthaff.2018.05124.

    Article  Google Scholar 

  11. Caldwell JT, Ford CL, Wallace SP, Wang MC, Takahashi LM. Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States. Am J Public Health. 2016;106(8):1463–9. https://doi.org/10.2105/AJPH.2016.303212.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Martin AB, Probst JC, Shah K, Chen Z, Garr D. Differences in readiness between rural hospitals and primary care providers for telemedicine adoption and implementation: findings from a statewide telemedicine survey. J Rural Health. 2012;28(1):8–15. https://doi.org/10.1111/j.1748-0361.2011.00369.x.

    Article  PubMed  Google Scholar 

  13. Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Why some dermatologists do not practice store-and-forward teledermatology. Arch Dermatol. 2012;148(5):649–50. https://doi.org/10.1001/archdermatol.2012.42.

    Article  PubMed  Google Scholar 

  14. Barbieri JS, Nelson CA, Bream KD, Kovarik CL. Primary care providers' perceptions of mobile store-and-forward teledermatology. Dermatol Online J. 2015;21(8):13030/qt2jt0h05w.

    PubMed  Google Scholar 

  15. Moore MA, Coffman M, Jetty A, Klink K, Petterson S, Bazemore A. Family physicians report considerable interest in, but limited use of, telehealth services. J Am Board Fam Med. 2017;30(3):320–30. https://doi.org/10.3122/jabfm.2017.03.160201.

    Article  PubMed  Google Scholar 

  16. Lin CC, Dievler A, Robbins C, Sripipatana A, Quinn M, Nair S. Telehealth in health centers: key adoption factors, barriers, and opportunities, Health Aff (Millwood). 2018;37(12):1967–74. https://doi.org/10.1377/hlthaff.2018.05125.

  17. Mansouri-Rad P, Mahmood MA, Thompson SE, Putnam K. Culture matters: factors affecting the adoption of telemedicine. HICSS '13: Proceedings of the 2013 46th Hawaii International Conference on System Sciences. 2013; 2515–24. https://doi.org/10.1109/HICSS.2013.157.

  18. Dowling KH. Exploring Perceptions of Dermatology Access and the Adoption of Consultative Telederm Among Primary Care Providers in Rural Mississippi Submitted in partial fulfillment of the requirements for the degree of Doctor of Health Administration. School of Health Related Professions University of Mississippi Medical Center Jackson, Mississippi March 2020.

    Google Scholar 

  19. Bertrand SE, Weinstock MA, Landow SM. Teledermatology outcomes in the providence veterans health administration. Telemed J E Health. 2019;25(12):1183–8. https://doi.org/10.1089/tmj.2018.0242.

    Article  PubMed  Google Scholar 

  20. Marchell R, Locatis C, Burgess G, Maisiak R, Liu WL, Ackerman M. Patient and provider satisfaction with teledermatology. Telemed J E Health. 2017;23(8):684–90. https://doi.org/10.1089/tmj.2016.0192.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Resnick JS, Abrouk M, Steuer M, Tam A, Yen A, Lee I, Covarick CL, Edison KE. Choice, transparency, coordination, and quality among direct-to-consumer telemedicine websites and apps treating skin disease. JAMA Dermatol. 2016;152(7):768–75. https://doi.org/10.1001/jamadermatol.2016.1774.

    Article  Google Scholar 

  22. Goodspeed TA, Page RE, Koman LE, Hollenbeck AT, Gilroy AS. Legal and regulatory issues with teledermatology. Curr Dermatol Rep. 2019;8(2):46–51. https://doi.org/10.1007/s13671-019-0254-0.

    Article  Google Scholar 

  23. Stevenson P, Finnane AR, Soyer HP. Teledermatology and clinical photography: safeguarding patient privacy and mitigating medico-legal risk. Med J Aust. 2016;204(5):198–200. https://doi.org/10.5694/mja15.00996.

    Article  PubMed  Google Scholar 

  24. Bhate C, Ho CH, Brodell RT. HIPAA and teledermatology in the age of COVID-19. J Am Acad Dermatol. Accepted 6/25/20.

    Google Scholar 

  25. Trout KE, Rampa S, Wilson FA, Stimpson JP. Legal mapping analysis of state telehealth reimbursement policies. Telemed J E Health. 2017;23(10):805–14. https://doi.org/10.1089/tmj.2017.0016.

    Article  PubMed  Google Scholar 

  26. Capistrant G. Medicare coverage and reimbursement policies. In: Rheuban K, Krupinski EA. eds. Understanding telehealth [Internet] New York City: McGraw-Hill; 2018. [cited 2020 Jul 20] Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=2217&sectionid=187795807

  27. Lenert L, BY MS. Balancing health privacy, health information exchange, and research in the context of the COVID-19 pandemic. J Am Med Inform Assoc. 2020;27(6):963–6. https://doi.org/10.1093/jamia/ocaa039.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Senate Bill 2209 2013 (Mississippi).

    Google Scholar 

  29. Senate Bill 2646 2014 (Mississippi).

    Google Scholar 

  30. Chuchvara N, Patel R, Srivastava R, Reilly C, Rao BK. The growth of teledermatology: Expanding to reach the underserved. J Am Acad Dermatol. 2020;82(4):1025–33. https://doi.org/10.1016/j.jaad.2019.11.055.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Ross Pearlman, MD, for providing Figures 15.4–15.6.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Doo, C., Petruzzelli, C., Dowling, K., Brown, A.S., Brodell, R.T. (2021). Overcoming Barriers to Implementation of Teledermatology in Rural America. In: Brodell, R.T., Byrd, A.C., Firkins Smith, C., Nahar, V.K. (eds) Dermatology in Rural Settings. Sustainable Development Goals Series. Springer, Cham. https://doi.org/10.1007/978-3-030-75984-1_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-75984-1_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-75983-4

  • Online ISBN: 978-3-030-75984-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics