Analysis of availability, types, and implementation of teledermatology services during COVID-19.

To the Editor: Given the rapid increase in teledermatology because of the coronavirus disease 2019 (COVID-19) pandemic, we analyzed variations in teledermatology services across the country between academic and private practices. Three private practices were randomly selected for each state and Washington, DC, from the American Academy of Dermatology member list. Additionally, for each state we selected the academic institution with the greatest number of dermatology residents. Only practices with a website were included.

A total of 153 private practices' websites and linked social media accounts were analyzed on April 22. Use of websites had the advantage over calling in that it allowed us to capture a large sample in a single day. One hundred thirty-three practices had an update regarding changes in practices because of COVID-19. Of those, 86.5% indicated that teledermatology was an option for patients in lieu of an in-person appointment. A total of 42.6% of practices indicated use of live video conferencing, and 48.7% did not specify what platform they would use to conduct the appointment and that patients would need to contact their office for more information. One private practice indicated the use of photographs for the telemedicine visit. A total of 92.2% of private practices did not provide information for patients on their website regarding what conditions would be most appropriate for a telemedicine visit.

Of the 40 academic institutions analyzed, almost all mentioned telemedicine as an option for certain specialties on the main webpage; however, only 60% of dermatology departments specifically mentioned teledermatology services. Of those, 50% used a video platform. Only 1 academic institution mentioned the use of photographs as their platform for the televisit. A total of 20.8% indicated that both video and photograph or an e-visit was available as an option. Twenty-five percent did not specify the type of platform they used. Only 16.6% provided specific public instructions regarding how to take photographs for virtual care such as taking them in a well-lit area, focusing the image, or not using the zoom feature. A total of 95.8% of institutions that offered teledermatology did not provide information indicating what conditions would be appropriate for evaluation through teledermatology.

Most academic and private practices offer teledermatology as an alternative in response to COVID-19. Compared with private practices, academic institutions provided less specific information on their websites regarding alternative options. However, it is clear that implementation is highly variable. Although many visits may be follow-ups of chronic inflammatory conditions, for accurate diagnoses, high-resolution images are necessary, and still photographs may have a resolution advantage over video alone. Despite that, video, possibly because of reimbursement, was more widely implemented. Still images must be in focus, have multiple viewpoints, and clearly indicate the lesion or area of concern. Unfortunately, we found little previsit guidance. Our study suggests that, if reimbursement drove selection of video visits, it should be systematically compared with photography to evaluate outcomes. Second, this highlights practice gaps (eg, image production) in which American Academy of Dermatology patient guidelines may be useful.

Although our study evaluated early COVID-19 practices, future studies may be valuable in elucidating how teledermatology evolves.