Anchorage, Alaska — As teledermatology gains acceptance throughout the healthcare field, dermatologists must ensure that they and their residents are comfortable with this technology, according to one expert.

Dr. Bocachica

Telemedicine is growing rapidly to meet patient needs, Dr. Bocachica says. A decade ago, "You might have found perhaps 25 papers online about telemedicine. Today, there's a complete plethora."

Telemedicine refers to the transfer of medical information via phone, Internet, satellite or other networks for the purpose of consulting, Dr. Bocachica says.

"As is the case in the battle theaters of the Middle East right now, you can sometimes perform remote medical procedures or examinations via a telemedicine server," he says.

Teledermatology uses high-resolution images, usually accompanied by a patient history, "preferably brief," Dr. Bocachica says. Such networks typically include non-dermatologic physicians and other healthcare professionals who use a teledermatology cart or platform at the point of care to capture and transmit necessary data to a consulting dermatologist virtually anywhere in the world.

Live interactive telemedicine includes a videoconferencing link so that the off-site consultant can interact with the patient if needed. Conversely, Dr. Bocachica says store-and-forward telemedicine has proven more popular because it allows remote consultants to review cases on their own schedules. Additionally, some sites use a hybrid model that combines real-time interaction and static images for applications such as follow-up appointments.

"It takes three months to see me face-to-face," Dr. Bocachica says. But with store-and-forward teledermatology, "I can get an answer back to the physician within 48 hours."

The ANMC's carts include a PC, complete with monitor, keyboard and mouse; a scanner; a digital camera and other peripherals, including an otoscope. All told, each cart costs $25,000, Dr. Bocachica says, "But it's well worth it." However, he says a simpler setup including a PC, a digital camera, a network infrastructure and a willing operator can suffice if needed.

"Remember, the people at the originating sites have varying degrees of medical education," he says. For example, the ANMC network employs community health aides whose only medical training is a six-week intensive course.

"They're taught the basics — how to recognize when someone is in trouble, or an image that needs to be photographed. They don't have to know what it is — they just have to know how to take the photograph and send it to me," Dr. Bocachica says. The ANMC cart employs color coding and user-friendly templates to guide operators through these processes.

"Training is critical," Dr. Bocachica says. "I travel to six or seven major areas in Alaska every year," along with telehealth technical coordinators, to provide training and answer field operators' questions. Additionally, "We have a specific camera training course that we offer several times yearly."