AccessDerm: Serving the underserved
In Practice
By Dean Monti, managing editor, special publications, September 2, 2019
Dermatology World speaks with Cory Simpson, MD, PhD, about why he uses AccessDerm — the Academy's volunteer teledermatology platform — how it works, and why others should get involved.
Dermatology World: Why is AccessDerm important?
Dr. Simpson: AccessDerm expands the reach of dermatologists to help patients and providers who lack access to our specialty, but desperately need our help to triage and treat what can be debilitating, disfiguring, or even deadly skin conditions. Because dermatologists are in such high demand, often with long wait-times for new appointments, this can cause delays in care, which unfortunately more often affect those of limited means. Employing the free, smartphone-compatible, and easy-to-use AccessDerm teledermatology platform can help reduce critical health care disparities in dermatology by connecting board-certified dermatologists to under-served communities, whether in rural areas or urban impoverished neighborhoods.
Dermatology World: When you explain the value of AccessDerm to others, what do you say?
Dr. Simpson: AccessDerm lets me give back to my community, expand access to our specialty, and help disadvantaged patients with a few simple swipes on my smartphone. An amazing thing about AccessDerm is that I can answer consults no matter where in the world I happen to be or what time of day it is. If I have a spare moment while riding to work, waiting at an airport, or during a no-show clinic appointment, I can use that downtime to provide some advice to a PCP caring for a patient in need. The teledermatology program also allows me the opportunity to e-teach the PCPs through explaining my diagnostic thought process for a rash or my therapeutic ladder for a disease. As our partnership with a local charitable clinic has matured over the years, I’ve noticed that PCPs now send me impressive differential diagnoses and have often already tried the first-line therapy I’ve recommended for prior cases.
Dermatology World: How did you find out about AccessDerm? Why did you get involved?
Dr. Simpson: I first signed up for AccessDerm as a dermatology resident at Penn. Carrie Kovarik, MD, was using the platform to provide consultations to the public city clinics of Philadelphia, and I thought it was an amazing opportunity to learn how to effectively use teledermatology while providing a service for disadvantaged patients.
When I was a senior resident, I had taken over the coordinator role for a separate monthly outreach clinic called Puentes de Salud (“Bridges of Health”), which serves only uninsured patients, most of whom are Hispanic immigrants. I realized that many of the referrals we received were fairly simple like acne or were larger surgical issues that were inappropriate for an outpatient dermatology clinic. So, Jules Lipoff, MD, and I collaborated with a medical student, Peter Chansky, MD (now a dermatology resident at NYU), to train the PCPs to use AccessDerm and started requiring a teledermatology consult prior to scheduling an in-person appointment. For the majority of cases, we were able to provide a working diagnosis and treatment plan based on teledermatology alone without need for in-person evaluation. This teletriage system allowed us to take patients out of the dermatology queue and reduce the wait-time to obtain specialist input.
In essence, AccessDerm lets us “see” more total patients, while reserving our limited in-person appointments for more urgent concerns and complex patients, who most need our help.
Dermatology World: Briefly run us through the AccessDerm process. How does it work?
Dr. Simpson: AccessDerm utilizes a provider-to-provider consultative model (as opposed to direct-to-consumer) in which PCPs submit cases and dermatologists reply to the PCP. It utilizes a store-and-forward workflow in which static photos are reviewed by an off-site dermatologist sometime after the in-person PCP appointment (asynchronous) rather than using real-time-video.
You need a volunteer, board-certified dermatologist who is willing to sign up with the AAD and donate time to answer teledermatology consultations from PCPs. Second, you need a clinic within the dermatologist’s state of licensure that serves patients with limited access to dermatology, whether they face geographic, financial, cultural, or legal barriers to care. The AAD has staff dedicated to help match dermatologists with clinics and then provide training on how to use the AccessDerm platform.
When the PCP identifies a patient for whom a dermatologist’s input is needed, he or she logs into AccessDerm either on a smartphone or a desktop computer, provides some basic demographic and historical information, and uploads photos. The partner dermatologist receives an email notification about the case, logs into AccessDerm (also on a smartphone or any desktop computer) at his or her convenience, then sends back a provisional diagnosis and treatment plan, which can be implemented by the PCP. Importantly, even if the lesion or rash cannot be easily diagnosed from photographs or requires a procedure, the dermatologist’s recommendation to seek an in-person evaluation is valuable and he or she can also let the PCP and the patient know if the concern is urgent (e.g., worrisome for a skin cancer), which can expedite care.
Dermatology World: Why should others volunteer and get involved with AccessDerm?
Dr. Simpson: AccessDerm offers dermatologists a convenient way to give back to their communities and put their expertise to good use by helping under-served patients. By giving up just a few minutes of Facebook scrolling, I can swipe over to the AccessDerm app and answer a consult or two before bed. It also offers an opportunity to connect with under-resourced PCPs in your state, build collaborative relationships, teach them some basic dermatology, and demonstrate the value of our specialty’s input. AccessDerm can also make volunteer clinics more efficient. Many AAD members participate in charitable outreach clinics and could use AccessDerm, as we have at Penn, to help reduce the wait times for an in-person appointment by taking the simpler cases out of the queue. Finally, dermatologists using AccessDerm will hone their own valuable skills in teledermatology as we enter a new era of telemedicine.
Dermatology World: Is there anything personally rewarding about your work with AccessDerm that you’d like to add?
Dr. Simpson: AccessDerm has allowed me to become a resource for the PCPs at Puentes de Salud, our local charity clinic, which has been very rewarding. Together, we have collaborated on interesting and challenging cases. One example was a case triaged as needing a biopsy, which turned out to diagnose a rare cancer syndrome. We published that case (Dermatology Online Journal, 24(4). Retrieved from https://escholarship.org/uc/item/3nf839r6) as well as our teletriage initiative (J Am Acad Dermatol. 2017 Nov;77(5):975-977) and hoped these articles would encourage others to utilize AccessDerm to make their outreach clinics more efficient and offer potentially life-saving advice for patients in need. Through my work in AccessDerm, I’ve also been approached by several wonderful students and residents interested in health care disparities, who wanted to get involved with our outreach program or do teledermatology research. This has given me the opportunity to teach practical skills in teledermatology and the privilege to mentor some of the next generation of teledermatologists.
