Quantifying the Cost-Benefit of In-Person Dermatologic Care Versus Teledermatology in Urban and Rural Settings

INTRODUCTION Reframing Access Through Telemedicine As the demand for accessible and efficient healthcare grows, telemedicine has emerged as a transformative tool in closing gaps in patient care. Innovative technological advancements have bridged the opportunity for providers to offer consultations, diagnoses, and treatment plans remotely. Teledermatology, a division of telemedicine, virtually diagnoses, monitors and manages dermatologic conditions. Historically, teledermatology has encompassed three distinct modalities: store-and forward (SAF), real-time (RT)/live video (LV), and hybrid [1]. Through the SAF practice, health practitioners and/or patients capture images using various forms of technology, such as cell phones, and cameras. These photographs are then transmitted to dermatologists to be reviewed asynchronously. In the United States (US), SAF was first used in the mid 90s as a low-cost solution to address healthcare barriers in underserved rural populations in Oregon [2]. This approach allowed providers in Oregon to overcome logistical challenges of distance and specialist availability, enabling earlier evaluations for certain rural populations. Years later, the SAF modality was used more frequently to diagnose rashes and other dermatologic concerns. A study in 2009 reported that more than 80% of skin lesions assessed by pediatric dermatologists through SAF teledermatology were correctly treated [3]. This study highlighted the clinical reliability of SAF in management of common pediatric dermatologic conditions. Although the SAF practice has its advantages, some practitioners opt to use the RT/LV method of teledermatology.