Teledermatología | #DERMAeSalud AIES & Stiefel GSK

19:30h | TELEDERMATOLOGÍA Situación en diferentes Comunidades Autónomas.

Opciones en consulta pública y privada. Posibilidades y desafíos.

Dr Guillermo Romero Aguilera

Servicio de DermatologíaHospital General Universitario de Ciudad Real

SESCAM



1. Qué es teledermatología: concepto/tipos2. Situación en CCAA3. Opciones privadas4. Posibilidades y desafíos

SESCAM

Teledermatology practice…………………

OBJETIVO / PROPÓSITO : DX-MANEJO O SEGUIMIENTO

SOLO TD

TDFTF

FTFTD

1. PRIMARIA………PACIENTE TD DERMATÓLOGO

2. SECUNDARIA….PACIENTE MAP TD DERMATÓLOGO

3. TERCIARIA …….PACIENTE DERMATÓLOGO TD DERMATÓLOGO

MODELOS INTERACCIÓN EN TD

1

2

3



1. Qué es teledermatología: concepto/tipos

2. Situación en CCAA3. Opciones privadas4. Posibilidades y desafíos

SESCAM

Current Status of Teledermatology in Spain

Dr Guillermo Romero , Dr Diego de Argila*

Departments of DermatologyHospital General Universitario de C. Real and Hospital

Universitario La Princesa* de Madrid

SESCAM

Introduction

• It’s no clear if teledermatology can be considered a mature application 1.

• In fact it has been doubted his successful implantation in some countries with a long tradition in TD 2.

• However, there are no longitudinal studies evaluating its global development in a particular country.

1 Eminovic N et al Maturity of teledermatology evaluation research: a systematic literature review. Br J D 20072 English JS, Eedy DJ. Has teledermatology in the U.K. finally failed? Br J D 2007

Aims

• Current status of TD in Spain– Organization– Population & Pathology– Adventages & Disadventages

• Development of Spanish TD in last 5 years

Objective: To analyze the degree of implementation of TD in Spain and the most important qualitative and quantitative characteristics of functioning services. Theses include : organization, attended population, tecnology, teaching and researching, advantages and disadventages.We present the results of a comparative longitudinal study of two surveys conducted in 2009 and 2014 by the AEDV Image Group.

Methods• Survey:

– Dr. Romero & Dr. de Argila. (Imaging group AEDV)– Presentation letter– National distribution Abbvie

• Description current results 2014• Comparation with 2009 survey

The proposed access was different in the two surveys. In the first survey, in 2009, we have using a multi-pronged approach, we sought to identify dermatologists practicing teledermatology in Spain. We contacted the members of AEDV Image Group to identify practicing teledermatologists in Spain. In addition, we submitted a request via e-mail to dermatology department heads of the major hospitals in the country. We also demanded to the existing teledermatologists to identify other practicing teledermatologists who might not have been captured with the above outreach efforts.The approach in the second survey was holistic, integral, because using the Abbvit commercial net we could have contact with all dermatology services in the country (267 services)

Index• Organization aspects• Technical aspects• Teaching and researching• Adventages & disadventages.

Methods• Survey:

– Dr. Romero & Dr. de Argila. (Imaging group AEDV)– Presentation letter– National distribution Abbvie

• Description current results 2014• Comparation with 2009 surveyThe proposed access was different in the two surveys. In the first survey, in 2009, we have using a multi-pronged approach, we sought to identify dermatologists practicing teledermatology in Spain. We contacted the members of AEDV Image Group to identify practicing teledermatologists in Spain. In addition, we submitted a request via e-mail to dermatology department heads of the major hospitals in the country. We also demanded to the existing teledermatologists to identify other practicing teledermatologists who might not have been captured with the above outreach efforts.The approach in the second survey was holistic, integral, because using the Abbvit commercial net we could have contact with all dermatology services in the country (267 services)

All 267 centers in Spain were accessed in may 2014• 70 make TD (26%) • 45 filled a wide survey • 25 do not fill wide survey

64% agree to complete a wide survey …………and 36% don’t agree

Spanish centers with TD by autonomies 2009 vs 2014: 21 in 2009 / 70 in 2014

4/8

2/1

2/5

3/72/4

1/15

1/0

1/14

1/6

1/5 1/11/1

Increase >x3

Decrease in 2

Stable in 2

Increase in 9

Null in 5

1/2

0/1

Time service and survival over timeTime with TD

(years) Centers0-4 245-9 12>10 5

5 With >10 yearsSantiago 17

Don Benito 15Badajoz 12C-Real 10Sevilla 10

17/21 activePersist 14/17, 3 more Closed

2009

N= 41RANGE 0.3 TO 17 MEDIAN 4.93

> 10 5-9 < 40

5

10

15

20

25

30

5

12

24

Years with TD

CUESTIONES TÉCNICASOrganization aspects

Tele-dermatologists / Hospital

N = 3632%

37%

16%

5% 11%

Tele-Dermatologists

1234> 5

2009

1843%

1433%

1024%

Dermatologist in Center

1-45-89-15

617%

1542%

617%

38%

617%

Number of Teledermatologists

1234>5

Hours / Week

N = 43

1256%

629%

210%

15%

0,5 a 22 a 55 a 10>10

2009

1639%

1332%

820%

410%

0,5 a 22 a 55 a 10>10

Time to do TD

838%

1048%

314%

Specific time No specific time Other

2009

2252%

1331%

717%

With appointment list and specific time for TDNo specific time “in breaks”Other

Support with other labors in Hospital

N = 42

921%

3379%

Support Staff (nurses or other)

SINO

Data and Pictures

1466%

210%

524%

DOCTOR NURSE MIXED

2009

3479%

512%

49%

Who introduce the patient data?

MEDICAL DOCTORNURSEOTHER

3370%

817%

613%

Who take the pictures?

MEDICAL DOCTORNURSEOTHER

GP Centers

29% All kind, Near and far centers, but only a %- From 10 to 80%- Media 45%

N=42

14%, only 6/42, restricted to farest centers

2252%

1229%

614%

25%

Whole areaAll kind but only a % Only FarestSpecific types

52% Whole area, without

restrictions

How far are the centers?

314%

1047%

629%

210%

<30km 30-100km 100-1000km >1000km

2009

1746%

1643%

411%

Farest distance

<50 km50-100km>100 km

2475%

516%

39%

Nearest distance

<25km25-50km>50km

N = 37

CUESTIONES TÉCNICASTechnical aspects

What kind of Tele-consultation?

1467%

524%

210%Chart Title200935

83%

512%

25%

SF - TD REAL TIME

HYBRID

2014

Tertiary TD

My Department makes consultations to other departments with TD

Other dermatologists make consultations to my Department with TD

615%

3585%

YES, USUALLYSOMETIMESNEVER

12%

512%

3686%

YES, USUALLYSOMETIMESNEVER

N = 42

Pictures / Images

DIGITAL CAMERA BRIDGE

DIGITAL CAMARA HQ

DERMATOSCOPE MOBILE PHONE ECOGRAPH0

5

10

15

20

25

30

35

CAPTURE DISPOSITIVES (GP)

Series1

N = 41 (13 multiple)

Who design the TD system?Public system: Dermatologist & Informatics

HOSPITAL WORKERS (DERMA-TOLOGIST& INFORMATICS); 23IT COMPANY ADAPTED ; 12

IT COMPANY; 6

- IXEMAD - SULIME - BULL - TELEFÓNICA- CENTRICITY- MED VIZER- GENERAL ELECTRICS

Companies / Health Departments

- SERGAS- DERCAM- OSAKIDETZA

N = 41

Mixed: Software specifically adapted

Commercial Software

DATA COLLECTION DESIGN: TAKING PART DERMATOLOGIST

1362%

838%

SiNo

2009

2460%

1640%

YESNO

What kind of software?

14%

28%58%

Is it possible to explode the data?

NOSINS/NC

29%

27%

44% Free space to replyPredederminated and mandatory itemsmixed

What kind of software?26%

14%60%

Is it available a diagnosis codifi-cation?

NOYESNS/NC

N = 41

TD system is linked with electronic clinical history?

419%

1781%

Si No

200928; 64%

14; 32%

2; 5%

YESNONA

N = 44

Satisfaction with TD system(by dermatologists)

12%

717%

3481%

NS/NC0-55-10

MEAN 7.15

What kind of population and pathologies?

SPECIFIC CONDITIONS FOR TDPopulation targeted.

942%

943%

210%

15%

General Disperse Remote Prisons

2009

42%

31%

8%

8% 12%

General populationGeographic dispersionRemote PopulationPrisonsNursing Homes

Distribution of diseases

1257%

838%

15%

General Oncology Esthetic

2009

3461%

1425%

35%

59%

General DermatologyOncologyProffesional dermatosisOther

Direct Appointment in Surgery Room

1740%

2660%

YESNO

N = 43

Teaching & Researching

Research & Publications

1640%

2460%

Research results

YESNO

616%

3184%

Publications

YESNO

Tele-training to GPs

838%

733%

629%

No yes Seminars Teleconsultation

20092009

717%

717%

1331%

12%

1433%

WITH TELECONSULTATIONSEMINARS AND MEETINGSBOTHOTHERSNONE

N = 42

Patient Satisfaction Surveys

419%

1781%

YesNo

2009

820%

3380%

YESNO

Main problems to implement TD systems

210%

837%

419%

210%

524%

HIS Primary Care Gerency Other None

2009

613%

37%

1840%

37%

716%

49%

49%

MEDICAL GERENCYAPPOINTMENT SERVICE (HIS)PRIMARY CAREPATIENTSDERMATOLOGY DE-PARTMENTTECHNOLOGYOTHERS

N = 36 (8multiple)

Satisfaction with TD(Score 0-10)

Average (2014): 6,9

Average (2009): 6,3

Adventages & Disadventages

Adventages (dermatologist point of view) Score 0 10

Main advantages of using the system TD (qualify of 0-10, with 0 being strongly disagree, 10 Total agreement)

IMPROVE C

OMMUNICATION W

ITH GP

SCREE

NING OF C

OMMON DISEASES

PRIORIZATIO

N IN ONCOLO

GY

PRIORIZATIO

N OF EMER

GENCIES

SAVING VISI

TS AND PATIE

NTS TR

AVELS

IMPROVE G

P TRAINING

IMPROVE G

LOBAL P

ATIENT M

ANAGEMEN

T0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

7.66 7.648.29

7.857.60

6.906.60

DISADVENTAGES (dermatologist point of view)Main disadvantages or problems using the TD system qualify of 0-10, with 0 being the

problem does not exist at all, 10 very serious and difficult problem to solve):

DIFFICULT

COORDINATION W

ITH P

RIMARY C

ARE

LACK O

F DER

MATOLO

GISTS C

OOPERATIO

N

LACK O

F GPs C

OOPERATIO

N

PICTURES

WITH BAS Q

UALITY

RISK OF M

EDICAL M

ISTAKE

TIME C

ONSUMING

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

3.73

2.64

3.95

6.38

5.75

3.37

Summary of results I:Centers and organization.

• All Spain centers 267 were surveyed, 70 had TD (26.2%) • Increase 21 to 70, x3 in 5 years (2009 2014)• Progressive increase Time service: 59% <4a, 29% 5-9 a, 5 >10

años; Range 0.3-17 years, median 4.93y• In 5 years 14/17 active centers survive from 2009, <20% have

been closed.• In each serviceTD is a subunity, from 2009 there are an increase of

active dermatologists and TD hours by week.• Only 20% with nurse participing, specific time for performance

increase from 38 to 52% in SC,

Summary of results IITechnology

• SFTD is the predominant technique and this primacy continuous to increase (from 67 to 83%).

• 15% make Tele DSC, 13% use smart-phone, and 15% practice tertiary TD.

• Software only 20% commercial no adapted, 60% design with Dermatologist collaboration. Linked with e-HIS in 64% (only 19% in 2009);Codification <33%;

• Satisfaction with technology system 7.15 (mean) and only 20% <5 (score 0-10)

• Attention to disperse/remote fall 53% in 2009 to 39% in 2014; • Primary Care: only farest 15%, all type of centers 85%.

• More center are in Urban setting, 50% don’t assist any patient >50km.

• Pathology: all type 60%, oncology 25%

• GP-Learning in 66%

Summary of results IIIObjectives

Global satisfaction 6.3 in 2009 increase to 6.9 in 2014 (score 0-10)

>

Summary of results IVAdvantages & Disadvantages



1. Qué es teledermatología: concepto/tipos2. Situación en CCAA

3. Opciones privadas4. Posibilidades y desafíos

SESCAM

TD PRIVADA

TD PRIVADA

• Consentimiento.

• privacidad //https// cifrado// claves //

• Quien remite paciente?.

• Hay seguimiento?.

• Seguro médico / responsabilidad.

• Control de riesgos: calidad fotos y seguridad en dx.



1. Qué es teledermatología: concepto/tipos2. Situación en CCAA3. Opciones privadas

4. Posibilidades y desafíos PREGUNTAS

SESCAM

Teledermatología | #DERMAeSalud AIES & Stiefel GSK

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