The VA’s VISN 20 “NW Network News”, reports that a year ago no teledermatology services existed in VISN 20. Survey results showed that over 5,000 rural veterans in the VISN went without care due to the low number of dermatologists available.
Dr. Gregory Raugi, MD, PhD, and Gayle Reiber, PhD submitted a proposal to address the problem. VISN 20 made their proposal a 2009 clinical priority and entered the proposal in a VA National Competition for Rural Health Funds.
As a result, the Tele-Dermatology Project was awarded a grant in 2009. However, one of the conditions for the grant award required both Dr Raugi and Dr. Reiber to implement tele-dermatology services at a rural VA within one month. The Walla Walla VAMC accepted the challenge in June 2009, and became the first medical center in the VISN to provide rural tele-dermatology service.
In the past year, there have been a number of accomplishments. Twenty three rural sites now have primary care providers and teledermatology technicians. Primary care providers work in partnership with Board Certified dermatologists who recommend and teach dermatology patient care. The providers receive training in supervised dermatology skill development, problem solving, and one-on-one training is provided with a surgical dermatologist. The technicians have learned to take and upload images, facilitate patient follow-up, and assist the primary care providers with patient care.
The system works by having the teledermatology consults forwarded through the Computerized Patient Record System to Board Certified Dermatologist readers. Care is recommended based on the patient’s history and the primary care provider’s assessment and accompanying images. The turn-around time between receipt of the consultation and the time needed to provide recommendations is two days.
The goal by the end of FY 2010 is for the tele-dermatology primary care providers to complete their training and be able to manage up to 80 percent of dermatology problems locally. The plan is to have providers identify conditions beyond their scope of practice by continuing to refer to the dermatologist readers.
So far, 23 primary care providers and technician teams have served over 2,000 veterans with over 3,000 skin problems including malignancies identified in 17 percent of those served. Follow-up skin problem outcomes are carefully monitored by the core team and there are plans to expand to additional rural sites.