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19:30h | TELEDERMATOLOGÍA Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada. Posibilidades y desafíos.
Dr Guillermo Romero Aguilera
Servicio de DermatologíaHospital General Universitario de Ciudad Real
SESCAM
19:30h | TELEDERMATOLOGÍA Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada. Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos2. Situación en CCAA3. Opciones privadas4. Posibilidades y desafíos
SESCAM
19:30h | TELEDERMATOLOGÍA Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada. Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos2. Situación en CCAA3. Opciones privadas4. Posibilidades y desafíos
SESCAM
Teledermatology practice…………………
OBJETIVO / PROPÓSITO : DX-MANEJO O SEGUIMIENTO
SOLO TD
TDFTF
FTFTD
1. PRIMARIA………PACIENTE TD DERMATÓLOGO
2. SECUNDARIA….PACIENTE MAP TD DERMATÓLOGO
3. TERCIARIA …….PACIENTE DERMATÓLOGO TD DERMATÓLOGO
MODELOS INTERACCIÓN EN TD
1
2
3
19:30h | TELEDERMATOLOGÍA Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada. Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos
2. Situación en CCAA3. Opciones privadas4. Posibilidades y desafíos
SESCAM
Current Status of Teledermatology in Spain
Dr Guillermo Romero , Dr Diego de Argila*
Departments of DermatologyHospital General Universitario de C. Real and Hospital
Universitario La Princesa* de Madrid
SESCAM
Introduction
• It’s no clear if teledermatology can be considered a mature application 1.
• In fact it has been doubted his successful implantation in some countries with a long tradition in TD 2.
• However, there are no longitudinal studies evaluating its global development in a particular country.
1 Eminovic N et al Maturity of teledermatology evaluation research: a systematic literature review. Br J D 20072 English JS, Eedy DJ. Has teledermatology in the U.K. finally failed? Br J D 2007
Aims
• Current status of TD in Spain– Organization– Population & Pathology– Adventages & Disadventages
• Development of Spanish TD in last 5 years
Objective: To analyze the degree of implementation of TD in Spain and the most important qualitative and quantitative characteristics of functioning services. Theses include : organization, attended population, tecnology, teaching and researching, advantages and disadventages.We present the results of a comparative longitudinal study of two surveys conducted in 2009 and 2014 by the AEDV Image Group.
Methods• Survey:
– Dr. Romero & Dr. de Argila. (Imaging group AEDV)– Presentation letter– National distribution Abbvie
• Description current results 2014• Comparation with 2009 survey
The proposed access was different in the two surveys. In the first survey, in 2009, we have using a multi-pronged approach, we sought to identify dermatologists practicing teledermatology in Spain. We contacted the members of AEDV Image Group to identify practicing teledermatologists in Spain. In addition, we submitted a request via e-mail to dermatology department heads of the major hospitals in the country. We also demanded to the existing teledermatologists to identify other practicing teledermatologists who might not have been captured with the above outreach efforts.The approach in the second survey was holistic, integral, because using the Abbvit commercial net we could have contact with all dermatology services in the country (267 services)
Index• Organization aspects• Technical aspects• Teaching and researching• Adventages & disadventages.
Methods• Survey:
– Dr. Romero & Dr. de Argila. (Imaging group AEDV)– Presentation letter– National distribution Abbvie
• Description current results 2014• Comparation with 2009 surveyThe proposed access was different in the two surveys. In the first survey, in 2009, we have using a multi-pronged approach, we sought to identify dermatologists practicing teledermatology in Spain. We contacted the members of AEDV Image Group to identify practicing teledermatologists in Spain. In addition, we submitted a request via e-mail to dermatology department heads of the major hospitals in the country. We also demanded to the existing teledermatologists to identify other practicing teledermatologists who might not have been captured with the above outreach efforts.The approach in the second survey was holistic, integral, because using the Abbvit commercial net we could have contact with all dermatology services in the country (267 services)
All 267 centers in Spain were accessed in may 2014• 70 make TD (26%) • 45 filled a wide survey • 25 do not fill wide survey
64% agree to complete a wide survey …………and 36% don’t agree
Spanish centers with TD by autonomies 2009 vs 2014: 21 in 2009 / 70 in 2014
4/8
2/1
2/5
3/72/4
1/15
1/0
1/14
1/6
1/5 1/11/1
Increase >x3
Decrease in 2
Stable in 2
Increase in 9
Null in 5
1/2
0/1
Time service and survival over timeTime with TD
(years) Centers0-4 245-9 12>10 5
5 With >10 yearsSantiago 17
Don Benito 15Badajoz 12C-Real 10Sevilla 10
17/21 activePersist 14/17, 3 more Closed
2009
N= 41RANGE 0.3 TO 17 MEDIAN 4.93
> 10 5-9 < 40
5
10
15
20
25
30
5
12
24
Years with TD
CUESTIONES TÉCNICASOrganization aspects
Tele-dermatologists / Hospital
N = 3632%
37%
16%
5% 11%
Tele-Dermatologists
1234> 5
2009
1843%
1433%
1024%
Dermatologist in Center
1-45-89-15
617%
1542%
617%
38%
617%
Number of Teledermatologists
1234>5
Hours / Week
N = 43
1256%
629%
210%
15%
0,5 a 22 a 55 a 10>10
2009
1639%
1332%
820%
410%
0,5 a 22 a 55 a 10>10
Time to do TD
838%
1048%
314%
Specific time No specific time Other
2009
2252%
1331%
717%
With appointment list and specific time for TDNo specific time “in breaks”Other
Support with other labors in Hospital
N = 42
921%
3379%
Support Staff (nurses or other)
SINO
Data and Pictures
1466%
210%
524%
DOCTOR NURSE MIXED
2009
3479%
512%
49%
Who introduce the patient data?
MEDICAL DOCTORNURSEOTHER
3370%
817%
613%
Who take the pictures?
MEDICAL DOCTORNURSEOTHER
GP Centers
29% All kind, Near and far centers, but only a %- From 10 to 80%- Media 45%
N=42
14%, only 6/42, restricted to farest centers
2252%
1229%
614%
25%
Whole areaAll kind but only a % Only FarestSpecific types
52% Whole area, without
restrictions
How far are the centers?
314%
1047%
629%
210%
<30km 30-100km 100-1000km >1000km
2009
1746%
1643%
411%
Farest distance
<50 km50-100km>100 km
2475%
516%
39%
Nearest distance
<25km25-50km>50km
N = 37
CUESTIONES TÉCNICASTechnical aspects
What kind of Tele-consultation?
1467%
524%
210%Chart Title200935
83%
512%
25%
SF - TD REAL TIME
HYBRID
2014
Tertiary TD
My Department makes consultations to other departments with TD
Other dermatologists make consultations to my Department with TD
615%
3585%
YES, USUALLYSOMETIMESNEVER
12%
512%
3686%
YES, USUALLYSOMETIMESNEVER
N = 42
Pictures / Images
DIGITAL CAMERA BRIDGE
DIGITAL CAMARA HQ
DERMATOSCOPE MOBILE PHONE ECOGRAPH0
5
10
15
20
25
30
35
CAPTURE DISPOSITIVES (GP)
Series1
N = 41 (13 multiple)
Who design the TD system?Public system: Dermatologist & Informatics
HOSPITAL WORKERS (DERMA-TOLOGIST& INFORMATICS); 23IT COMPANY ADAPTED ; 12
IT COMPANY; 6
- IXEMAD - SULIME - BULL - TELEFÓNICA- CENTRICITY- MED VIZER- GENERAL ELECTRICS
Companies / Health Departments
- SERGAS- DERCAM- OSAKIDETZA
N = 41
Mixed: Software specifically adapted
Commercial Software
DATA COLLECTION DESIGN: TAKING PART DERMATOLOGIST
1362%
838%
SiNo
2009
2460%
1640%
YESNO
What kind of software?
14%
28%58%
Is it possible to explode the data?
NOSINS/NC
29%
27%
44% Free space to replyPredederminated and mandatory itemsmixed
What kind of software?26%
14%60%
Is it available a diagnosis codifi-cation?
NOYESNS/NC
N = 41
TD system is linked with electronic clinical history?
419%
1781%
Si No
200928; 64%
14; 32%
2; 5%
YESNONA
N = 44
Satisfaction with TD system(by dermatologists)
12%
717%
3481%
NS/NC0-55-10
MEAN 7.15
What kind of population and pathologies?
SPECIFIC CONDITIONS FOR TDPopulation targeted.
942%
943%
210%
15%
General Disperse Remote Prisons
2009
42%
31%
8%
8% 12%
General populationGeographic dispersionRemote PopulationPrisonsNursing Homes
Distribution of diseases
1257%
838%
15%
General Oncology Esthetic
2009
3461%
1425%
35%
59%
General DermatologyOncologyProffesional dermatosisOther
Direct Appointment in Surgery Room
1740%
2660%
YESNO
N = 43
Teaching & Researching
Research & Publications
1640%
2460%
Research results
YESNO
616%
3184%
Publications
YESNO
Tele-training to GPs
838%
733%
629%
No yes Seminars Teleconsultation
20092009
717%
717%
1331%
12%
1433%
WITH TELECONSULTATIONSEMINARS AND MEETINGSBOTHOTHERSNONE
N = 42
Patient Satisfaction Surveys
419%
1781%
YesNo
2009
820%
3380%
YESNO
Main problems to implement TD systems
210%
837%
419%
210%
524%
HIS Primary Care Gerency Other None
2009
613%
37%
1840%
37%
716%
49%
49%
MEDICAL GERENCYAPPOINTMENT SERVICE (HIS)PRIMARY CAREPATIENTSDERMATOLOGY DE-PARTMENTTECHNOLOGYOTHERS
N = 36 (8multiple)
Satisfaction with TD(Score 0-10)
Average (2014): 6,9
Average (2009): 6,3
Adventages & Disadventages
Adventages (dermatologist point of view) Score 0 10
Main advantages of using the system TD (qualify of 0-10, with 0 being strongly disagree, 10 Total agreement)
IMPROVE C
OMMUNICATION W
ITH GP
SCREE
NING OF C
OMMON DISEASES
PRIORIZATIO
N IN ONCOLO
GY
PRIORIZATIO
N OF EMER
GENCIES
SAVING VISI
TS AND PATIE
NTS TR
AVELS
IMPROVE G
P TRAINING
IMPROVE G
LOBAL P
ATIENT M
ANAGEMEN
T0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
7.66 7.648.29
7.857.60
6.906.60
DISADVENTAGES (dermatologist point of view)Main disadvantages or problems using the TD system qualify of 0-10, with 0 being the
problem does not exist at all, 10 very serious and difficult problem to solve):
DIFFICULT
COORDINATION W
ITH P
RIMARY C
ARE
LACK O
F DER
MATOLO
GISTS C
OOPERATIO
N
LACK O
F GPs C
OOPERATIO
N
PICTURES
WITH BAS Q
UALITY
RISK OF M
EDICAL M
ISTAKE
TIME C
ONSUMING
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
3.73
2.64
3.95
6.38
5.75
3.37
Summary of results I:Centers and organization.
• All Spain centers 267 were surveyed, 70 had TD (26.2%) • Increase 21 to 70, x3 in 5 years (2009 2014)• Progressive increase Time service: 59% <4a, 29% 5-9 a, 5 >10
años; Range 0.3-17 years, median 4.93y• In 5 years 14/17 active centers survive from 2009, <20% have
been closed.• In each serviceTD is a subunity, from 2009 there are an increase of
active dermatologists and TD hours by week.• Only 20% with nurse participing, specific time for performance
increase from 38 to 52% in SC,
Summary of results IITechnology
• SFTD is the predominant technique and this primacy continuous to increase (from 67 to 83%).
• 15% make Tele DSC, 13% use smart-phone, and 15% practice tertiary TD.
• Software only 20% commercial no adapted, 60% design with Dermatologist collaboration. Linked with e-HIS in 64% (only 19% in 2009);Codification <33%;
• Satisfaction with technology system 7.15 (mean) and only 20% <5 (score 0-10)
• Attention to disperse/remote fall 53% in 2009 to 39% in 2014; • Primary Care: only farest 15%, all type of centers 85%.
• More center are in Urban setting, 50% don’t assist any patient >50km.
• Pathology: all type 60%, oncology 25%
• GP-Learning in 66%
Summary of results IIIObjectives
Global satisfaction 6.3 in 2009 increase to 6.9 in 2014 (score 0-10)
>
Summary of results IVAdvantages & Disadvantages
19:30h | TELEDERMATOLOGÍA Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada. Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos2. Situación en CCAA
3. Opciones privadas4. Posibilidades y desafíos
SESCAM
TD PRIVADA
TD PRIVADA
TD PRIVADA
TD PRIVADA
TD PRIVADA
TD PRIVADA
• Consentimiento.
• privacidad //https// cifrado// claves //
• Quien remite paciente?.
• Hay seguimiento?.
• Seguro médico / responsabilidad.
• Control de riesgos: calidad fotos y seguridad en dx.
19:30h | TELEDERMATOLOGÍA Situación en diferentes Comunidades Autónomas.
Opciones en consulta pública y privada. Posibilidades y desafíos.
1. Qué es teledermatología: concepto/tipos2. Situación en CCAA3. Opciones privadas
4. Posibilidades y desafíos PREGUNTAS
SESCAM
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