Teledermatology is an increasingly utilized method of dermatologic care delivery, which is rapidly evolving and improving with advancement in technology.1, 2 It has moved beyond the telephone, email, and videoconferencing, and now can be accessed via a myriad of mobile apps for smartphones and tablets as well.5
The Canadian Dermatology Association supports the growing field of teledermatology, which will allow easier access to dermatologic care to patients who may not otherwise have been able to access dermatologic care.2
Teledermatology in Canada is generally delivered in two different settings1, 2:
Used where a primary care physician or a nurse practitioner consults a dermatologist.
Used where a patient directly consults a primary care physician, nurse practitioner, or a dermatologist.
There are two main types of patient-to-physician teledermatology:
- Synchronous1, 2
- Typically use live, real-time video conferencing via camera between the patient and the teledermatologist1,
- Similar to a traditional in-office visit but (at least at this time) tactile interaction is not possible2
- Asynchronous1, 2
- Uses the store-and-forward technique, whereby clinical dermatologic images obtained by the patient are stored and forwarded to the dermatologist, who can review the image and clinical history.1, 2
While telemedicine offers benefits for individual patients, there are some areas of challenge.1, 3
Currently, telemedicine from patient-to-physician is not a service covered by the provincial health insurance.4
Although access to a dermatologist generally requires a referral from a primary care provider in Canada, certain teledermatology services (i.e., DermaGo) allow direct patient access to a dermatologist.
Some questions to ask of telemedicine services include1, 2
- Does any insurance plan cover the cost of your services?
- What is the out-of-pocket cost?
- Is there additional cost for services offered, such as directly speaking with a physician regarding the assessment?
- Would I be assessed by a dermatologist? A family physician?
- How is follow-up care arranged?
- How are privacy and information security protected? (Most reputable telemedicine service providers employ a variety of protection mechanisms, such as passwords and encryption, to minimize the risk of unauthorized access to patient data.2)
- What is your policy regarding record keeping?
- Is your service available in my province/territory?
- What jurisdictions are the physicians licensed to practice in?
- For prescriptions to be considered valid in Canadian pharmacies, the prescribing physician needs to be licensed to practice in Canada.
- Some physicians practicing telemedicine in Canada might need to also be licensed in both the jurisdiction in which they are located and the jurisdiction where the patient is located.3
Links to some teledermatology services:
- DermaGO https://dermago.ca/en
- ConsultDERM™ – direct physician to physician https://www.raoderm.com/teledermatology/
- Maple https://www.getmaple.ca/providers/dermatologists/
3Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatol Pract Concept. 2018;8(3):214-223.
4Mounessa JS, Chapman S, Braunberger T, et al. A systematic review of satisfaction with teledermatology. J Telemed Telecare. 2018;24(4):263-270.