Personalized, Evolutionary, and Ecological Dermatology by Robert A. Norman

Author:Robert A. Norman
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Teledermatopathology

Modern advances in communication technology have propelled the use of teledermatopathology for the distant diagnosis of skin specimens. Teledermatopathology has many benefits, apart from allowing timely consultation from a remote location, it can help link rural and underserved communities that lack access to a subspecialty-trained dermatopathologist. In addition, teledermatopathology can save both time and money by eliminating the cost and time associated with sending glass slides [16, 17]. Despite these potential benefits, teledermatopathology is still not used routinely. The major hurdles that prevent its wide adoption are concerns about diagnostic accuracy, the state-to-state variation in licensure requirement and reimbursement [18].

There are three main approaches to transmitting the images: static store and forward system, live real-time transmission, and a hybrid virtual slide systems (VSS). Static store and forward system involves the transfer of individually captured digital images of the histologic slides at varied magnifications subjectively selected by the referring pathologist [19]. These images are then transmitted to a consulting pathologist either by e-mail, File Transfer Protocol connection, or using a specific Web application [19]. This technology is relative simple and less expensive than other methods. Most recently, the technology has evolved from static-image based systems to whole slide scanning. The recent introduction of virtual slide systems (VSS) enables the digitization of whole slides at high resolutions thus enabling the user to view any part of the specimen at any magnification [16]. The VSS images are then stored on the server and made available on the web via an integrated VS client network [19]. Another approach is an attempt to reproduce a live, real-time examination of slides via remotely controlled robotic technology. This technology allows consulting pathologists to examine the entire slide digitally with control over slide movement and magnification. Real-time teledermatopathology is more appealing to most pathologists because it closely resembles the established technique of traditional pathologic examination [19].

Many studies have compared the diagnostic accuracy of static image and whole slide imaging system with that of traditional light microscopy. A recent review of studies conducted between 1997 and 2012 comparing the store and forward technology with traditional light microscopy reveals the diagnostic accuracy of the store and forward method to be similar or inferior to conventional light microscopy [18]. However, with improved technology, later studies have shown better diagnostic accuracy. In terms of licensure, most states require out of state physicians to obtain a full in-state medical license in dermatopathology/pathology in order to practice teledermatopathology. Some states allow alternatives to obtaining a full in-state license and a few states will allow physicians to practice teledermatopathology as long as the diagnoses are made infrequently [18]. Similar to licensing, physician reimbursement is state- and payer-dependent. In all states, teledermatopathology is covered by Medicare with billing similar to those performed by an on-site dermatopathologist [18]. Medicaid and private payers coverage and reimbursement varies. Currently, 15 states explicitly mandate that private payers cover telemedicine services, with another 14 states making proposals to state legislature [18].

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