Teledermatology in a changing health care environment.

To avoid marginalization and an attendant decline in the quality of care delivered, dermatologists must take the lead in defining those services that can be delivered remotely and move aggressively to create standards of nomenclature, protocols for imaging, and methods of care delivery that can be implemented in a primary-care setting. Because of the rigorous training of its practitioners in visual analysis, it may be possible for dermatology to shift from its traditional face-to-face model to an image-based, remotely practiced one. Transition to remote practice may even be critical to the survival of the specialty. Chief among the issues in the implementation of teledermatology is whether the use of video conferencing or store-and-forward technology provides the most efficient, high-quality remote diagnosis. Ancillary issues, including image protocols, bandwidth requirements, reimbursement, licensing, liability, and patient and provider satisfaction, are important as well. These issues are discussed in a framework of capitated payment in urban, integrated delivery systems. Teledermatology has many challenges to meet before competing with face-to-face delivery of dermatologic care.