Menn E R, Kvedar J C
Department of Dermatology, Massachusetts General Hospital-Harvard Medical School, Boston, USA.
Telemed J. 1995 Winter;1(4):303-8.
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.
为避免边缘化以及随之而来的医疗服务质量下降，皮肤科医生必须率先界定那些可以远程提供的服务，并积极采取行动制定命名标准、成像方案以及可在初级保健环境中实施的护理提供方法。由于皮肤科医生在视觉分析方面接受过严格培训，皮肤科有可能从传统的面对面模式转变为基于图像的远程诊疗模式。向远程诊疗模式的转变甚至可能对该专业的生存至关重要。实施远程皮肤病学的首要问题是使用视频会议还是存储转发技术能提供最有效、高质量的远程诊断。包括图像协议、带宽要求、报销、许可、责任以及患者和提供者满意度等附属问题也很重要。这些问题将在城市综合医疗服务体系中按人头付费的框架内进行讨论。在与面对面的皮肤科护理竞争之前，远程皮肤病学还有许多挑战需要应对。
