Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme - Final report volume 2

Program structure

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The Tele-Derm program has been integrated as part of the Rural and Remote Education Online (RRMEO) portal. RRMEO provides access to a broad range of tools that support education and development for rural and remote doctors. Including Tele-Derm within the portal allows for the infrastructure and audience that has already been developed for RRMEO to be directly integrated with MSOAP. ACRRM has approximately 3,000 members, with an additional 7,000 people who are members of organisations that have purchased access to RRMEO, including groups such as registrars and John Flynn Scholars. Of the ~10,000 people with access to RRMEO, greater than 7,500 would be eligible to register for Tele-Derm.

For individuals that are eligible to register for RRMEO, a separate registration process is still required to participate in Tele-Derm. As part of the funding that MSOAP provides, any doctor eligible for MSOAP funding can apply for access to Tele-Derm. For doctors who register through MSOAP, they are provided access solely to the Tele-Derm portion of the RRMEO portal.

There are two main components to the Tele-Derm portal, a specific telemedicine component and a telehealth component. Telemedicine in this case is defined as traditional clinical medical services provided over a distance using electronic communication. With Tele-Derm, the telemedicine component is delivered through a store and forward (asynchronous) method where a doctor submits pictures and case information to the site for the dermatologist to diagnose and respond. This type of service is in contrast to ‘real-time’ telemedicine where a live teleconference occurs between patients and doctors. Telehealth in this case is defined as the use of information and communication technology for administration and education in addition to clinical services. ACRRM has made education a major component of Tele-Derm, indicating that the educational component is as or more important than the direct clinical services that are provided through the program.

The telemedical component of the program is based on the store and forward model, where cases are submitted by doctors and then at a later time the dermatologist provides a response that can then be accessed by the doctor. A doctor will submit a set of pictures and case information to the website, a process which feedback has indicated takes around 20-40 minutes for the GP to prepare. The GP does not receive any payment from ACRRM or Medicare for this service. Once the case is submitted, the ACRRM dermatologist accesses the case and writes a response that is made available to both the submitting doctor and all other Tele-Derm users. The case information is always left deidentified, but ACRRM does keep a record of the doctor who submitted the case.

In general, responses by the dermatologist are returned within 24 hours of initial submission, though the turnaround can be significantly shorter. A new feature has been developed for urgent cases to use SMS notification to speed up the process. When an urgent case is submitted, the dermatologist receives a SMS notifying him of the submission. When he responds, the doctor who submitted the request receives a SMS to alert them that a response has been posted.

Within the Tele-Derm portal there are several main areas that can be accessed by registered users: submitted cases, a dermoscopy atlas, a condition index, tips from the dermatologist and discussion forums. All cases that have been submitted can be viewed by all registered users of the program. Overall, there are 543 standard cases plus 186 dermoscopy cases that can be viewed by doctors to read and learn from, including the ability to guess at diagnoses and then have the answer revealed. Both the dermoscopy atlas and the condition access are designed to allow doctors to educate themselves on conditions and improve their self-diagnostic capabilities without having to submit every case directly. There is also an educational section written by the dermatologist to provide tips and tricks related to dermatology. For example, there is information on procedures, including biopsies and cryosurgery, how to take a good skin history from a patient, how to take good dermatology photographs and a list of other useful websites. Finally, the online discussion forums allow for doctors and the dermatologist to interact, learn and discuss dermatology cases.

Evidence indicates that many of the users of the portal are there for educational purposes rather than a direct clinical need. For example, registrars will often visit to learn and study for their training. Medical students can use the portal for similar purposes.

In order to generate interest and participation in the program, ACRRM has a case of the week that is e-mailed to all users. This involves a picture and a short description. Users can then click on the case to read the full details and then submit a response of their diagnosis of the case. At the end of the week, the ACRRM dermatologist provides a full discussion and diagnosis of the case in addition to responding to all of the comments posted throughout the week. Overall, the dermatologist provides about 1,000 comments per year in response to postings in the forums. General marketing of the Tele-Derm program is through the ACRRM website and advertisements are placed in all of the state specialist directories.