Why you can trust digital dermatology

20 december 2021 / Duncan Fisher

Clinical excellence is tested and assured

If patient numbers are anything to go by, we’re hooked on digital medicine now. That should be no surprise, with easy access to the web, a general expectation that services simply ought to be online where possible, and the recent need to conduct business safely through the pandemic. Reasonably enough, online medical consultations are exploding, exactly as everyone predicted. It’s hard to say when, or if, this market will ever saturate. Doctors approve of telemedicine for its ease and efficiency. Patients like its speedy end-run around clinic waiting lists, and they like not having to travel. Insurers and employers, because the service is so prompt, appreciate how health problems can be sorted out early, before they turn complicated and expensive. The overall concept of doctors online does seem to be living up to its promise.

Is the service really that good? Detractors worry that the system can be gamed, by people seeking controlled drugs, for example, or that health information in cyberspace may not be safe. They fret over pixels and resolution on screens through which diagnoses must be made. Surely, they think, a doctor always does a better job up close, in person. And what do you do if you need tests, or bloodwork?

Practioners, and IT experts and regulators, are already up to speed with problems like these. The online medical industry, young as it is, has matured surprisingly quickly. There are very good reasons to trust the system, and this should be reassuring to users and providers. The system works especially well in particular specialist areas. One of the most suitable is dermatology, which is what we do at Snapmed.

The technology works

One reason the service functions well in skin doctoring is the high quality of the cameras on contemporary phones (the device on which most consultations are seen). The resolution in the last couple of years, in both the ‘front’ and ‘back’ lenses, has grown easily fine enough for standard visual diagnostics in almost every skin condition. Another reason is the sheer processing power of the servers and software that crunch patient data. File sizes can be enormous and can be moved around quickly, and users have access to colossal resources for powering up their clinical practices. Artificial intelligence is even emerging with a role to play in diagnosis. And prescriptions online, by electronic paylink, are a breeze. Carefully done, this itself is a hedge against illicit prescribing.

But know the limitations

It is wise to know when not to use the service. In a way this, too, helps keep digital dermatology safe and appropriate for patients. Melanoma doctors, for example, are largely comfortable identifying harmless moles on their screens, and are confident about spotting obviously malignant lesions. For the in-between ones, however, safe diagnosis cannot be done remotely, and so they don’t try. This is true in some other syndromes as well.

The system is also not generally appropriate for acute conditions, or rapidly-changing ones. Nor should it be used, at least in a private, stand-alone setting, to manage complex or multi-team care needs. Some digital doctors (and they include those at Snapmed) do not attempt long-term care, either, or order up laboratory tests. These they refer to patients’ GPs, or in-person specialists. And they will not prescribe controlled or experimental drugs, or even drugs that require monitoring. The system is not for that.

Fortunately, most situations don’t involve any of these. At Snapmed, at least, 90% of what patients actually present resolves after routine diagnosis and treatment. Only 3% of things go undiagnosed, incidentally. That would be a good score even for an in-person examiner.

Online dermatology, in other words, works very well indeed.

Regulators are adapting

Governments and watchdog groups know this. Accreditation bodies like England’s Care Quality Commission and its counterpart, Healthcare Improvement Scotland, monitor and assure the integrity of each service’s policies and procedures, so that online medical care really is equivalent, as far as possible, to face-to-face care. This includes the basic granting of practicing privileges, all the protocols for evaluation and treatment, with provision for referral of acute cases. Rules for prescribing, and the tracking of what is prescribed, are very carefully laid out, as are reporting requirements for adverse reactions and ‘close calls’. Protocols are also in place to verify patient identity, to disclose the limitations of online medicine to patients, to detect and safeguard people at risk, to have clear channels for feedback and complaints, and to have schedules and mechanisms for continual quality assessment.

We’re a thing now

Telemedicine is up and running, is the bottom line. Because of the pandemic, it has arrived a little sooner than expected. But it’s running very well, all across the NHS and in private services like Snapmed. The service is expanding fast, and shows no sign of slowing. That’s good news for skin patients. Digital dermatology is an effective mode of delivery that dovetails perfectly with traditional in-person care, and it’s certainly as safe as any other trip to the doctor.