Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists

PLoS One. 2011;6(12):e28687. doi: 10.1371/journal.pone.0028687. Epub 2011 Dec 14.


Background: Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied.

Methods: The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California.

Results: Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers.

Conclusion: Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cooperative Behavior*
  • Demography
  • Dermatology / economics
  • Dermatology / statistics & numerical data*
  • Humans
  • Models, Theoretical*
  • Motivation
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Reimbursement Mechanisms / economics
  • Telemedicine / economics
  • Telemedicine / statistics & numerical data*
  • United States
  • Workforce