Skin cancers

Teledermoscopy accepted by dermatologists but lacks an MBS item


Most GPs and dermatologists appear to be receptive to store-and-forward teledermoscopy as a way to improve patient care.

An online survey of 59 healthcare practitioners, mostly in Australia, found most (92%) had previously participated in some form of teledermatology or teledermoscopy.

More than half had previously imaged lesions using dermatoscopes attached to smartphones or tablets for reasons including monitoring and follow-up of skin lesions, case documentation, referrals and second opinions, and teaching purposes.

While there were some barriers to the technology, such as time constraints, costs of purchasing equipment, image quality and data storage, 52% of participants said they believed mobile teledermoscopy could improve patient care.

However fewer (33%) intended to introduce mobile teledermoscopy into their routine practice.

Lead researcher Professor Monika Janda told the limbic one of the hold ups was probably the lack of a clear framework for mobile teledermoscopy or Medicare item numbers as there were for videoconferencing.

“While the technology is very good in principle and I think it works well, a practical framework still needs more development before practitioners would be confident they could use it well in their practice.”

Professor Janda, from the University of Queensland’s Centre for Health Services Research, said doctors wanted to be confident that patients would photograph the correct lesions and not overlook something significant.

“There are lots of things that still need clarification. As well as building a better framework in which this technology could be used to its optimal purposes, the other issue is finding the right applications.”

She said doctors were more comfortable if they had seen patients in the clinic first and educated them about which particular lesions to monitor.

The findings are consistent with earlier work, reported in the limbic, in which consumers reported they would like instructions on how to take good-quality image and help identify suspicious lesions.

Professor Janda said combinations of technology may also be useful.

“For example, at the moment it’s just picture taking but that could be combined with a video history in the future. Bringing in additional aspects to the technology might be another way forward.”

A randomised controlled trial of skin self examination with or without teledermoscopy has just completed with results to be reported later this year.

Two previous applications by the Australasian College of Dermatologists for Medicare items for Store and Forward have been rejected by the Medical Services Advisory Committee (MSAC). The College recently said it would need further clinical and economic evidence from pilot trials of teledermatology before making another submission to MSAC.

A lack of national guidelines for teledermatology is another barrier to gaining a MBS item for Store and Forward, and the College has commissioned the Centre for Online Health at the University of Queensland to develop practice guidelines for teledermatology for the Australian setting, with oversight from College’s E-Health Committee.

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