Forum for Nordic Dermato-Venereology No 3, 2019 Telemedicine | Page 6

Dermato-Venereology in the Nordic Countries Teledermatology in the Nordic Countries – Can We Practice High-quality, Easy-accessible Patient Care in a Safe and Responsible Way if We Serve Digitally? C arsten S auer M ikkelsen 1 , K ristian B akke A rvesen 2 , L uit P enninga 3 , and P eter B jerring 4 Research Lab, Department of Dermatology, University of Aalborg, and Private Dermatology Practice, Brønderslev, Denmark, 2 Resident in dermato-venereology, Department of derma- to-venereology, Aarhus University Hospital, Denmark, 3 Specialist in Surgery and Surgical Gastroenterology, PhD, Ilulissat Hospital, Avannaa Health Region, Greenland, 4 Professor, dr.med, Department of Dermatology, Aalborg University Hospital, Denmark. E-mail: c.s. [email protected] 1 B ackground Teledermatology is a subspecialty in the medical field of derma- tology and one of the most common applications of telemedi- cine and e-health (1). In teledermatology, telecommunication technologies are used to exchange medical information over a distance using audio, visual and data communication without face-to-face patient contact. Applications comprise health care management such as diagnosis, consultation and treatment as well as education (2). The preferred modalities of teledermatology are: “Live-Interac- tive“ and “Store-and-Forward“. In “Live-Interactive“ applica- tions, providers and patients interact via live-video-transmis- sions. A variety of peripheral hardware attachments may be utilized to enhance the consultation. In “Store-and-Forward“ applications, digital images and associated patient data are stored and sent to the dermatologist for consultation. Teledermatological programs already exist in all the Nordic countries and teledermatology is used for many different purposes. It is expected to see further development of teleder- matological applications in the future. One of the foundations of the Nordic healthcare systems is equal access to best possible high-quality health care, regard- less of social status and geographical location. That is the reason why the Nordic countries make large investments in the health care systems focusing on educating high quality specialists and offering the best treatment options and shortest possible waiting time. The implementation of telemedicine and tele-dermatology is in-line with the goals of the Nordic healthcare systems. The most important function of telemedicine is to increase ac- cess to health care and improve health outcomes. In addition, it should provide cost effective delivery, address shortages and 90 misdistribution of healthcare providers, support clinical educa- tion programs and improve support for patients and families. B enefits Teledermatology can be a proper tool to ensure better health care access for our citizens. Transport costs and long transport time to the nearest dermatologist, including loss of earnings for the patient, is a well-known health care issue in the Nor- dic countries, especially in remote areas in Sweden, Norway, Finland and Greenland. Teledermatology may have major benefits, especially for our patients living in remote areas where we can minimize the waiting time where it is longest. Further- more, teledermatology may also increase access for vulnerable groups, e.g. patients in prison, people with dementia, nursing home residents, psychiatric patients, etc. Teledermatology may also be applied for emergency cases. Many hospitals in the Nordic countries do not have a dermatologist on-call. Hence, emergency rooms and urgent care facilities manage most dermatological cases without any input from dermatologists. This lack of dermatology access outside office hours may lead to patients being managed in a less efficient and cost-effective manner. Dermatological specialist intervention may have a significant impact on care in emergency rooms and inpatients settings. Tele-dermatology in these settings can probably reduce unnecessary admissions and clinical costs. When changing healthcare practices special attention should be given to patient satisfaction. Qualitative studies should be performed to assess patient’s experiences with telederma- tology. Younger generations who have grown up with the electronical media may be very confident with this type of communication. Younger patients may even prefer consulta- tions via smartphones and other electronic devices instead of personal face-to-face communication. Teledermatological applications may also have a role in increasing compliance: Maybe patients with severe acne can obtain better adherence Forum for Nord Derm Ven 2019, Vol. 24, No. 3