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Opinion Article
Position Statement of the Spanish Academy of Dermatology and Venereology on Teledermatology
Posicionamiento de la Academia Española de Dermatología y Venereología sobre la teledermatología
D. Moreno-Ramíreza,
Autor para correspondencia
, G. Romero-Aguilerab, P. Pasqualic, S. Vañod, L. Ríos-Bucetad,e, J. Malvehyf, R. Tabernerg, L. Ferrándiza, e-Dermatology and Imaging Group of the Spanish Academy of Dermatology and Venereology
a Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
c Servicio de Dermatología, Hospital Pius de Valls, Valls, Tarragona, Spain
d Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
e Junta Directiva, Academia Española de Dermatología y Venereología, Madrid, Spain
f Servicio de Dermatología, Hospital Clínic, Barcelona, Spain
g Servicio de Dermatología Hospital Son Llàzter, Palma de Mallorca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Telemedicine is a reality in healthcare today and is considered to be of strategic importance by the World Health Organization&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Telemedicine improves the provision of healthcare services in areas with poor access to medical resources and enhances the quality of care in areas with better access&#46; Teledermatology &#40;TD&#41; is one of the most common applications of telemedicine&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">During the past decade&#44; Spain has become a world leader in TD services&#46; Between 2009 and 2014&#44; the number of TD programs in Spain increased significantly&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">TD has been shown to improve patient access to specialized care for specific skin conditions and to dermatologic care in general&#46; At the same time&#44; TD has also encountered obstacles and barriers that may have limited its use on a larger scale&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Spanish Academy of Dermatology and Venereology &#40;AEDV&#41; supports the rational application of TD to improve the quality of care for skin diseases provided that it meets a series of important criteria&#46; The association specifies that the practice of TD must always comply with the following set of basic standards&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TD refers to the use of information and communication technologies &#40;ICT&#41; in the care of skin diseases</span>&#46; TD is a complementary tool used in the practice of dermatology and&#44; as such&#44; must be used or coordinated solely by specialist dermatologists with the necessary skills and training in e-health processes and the use of ICT in medical practice&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Leadership of the dermatologist&#46;</span> The leadership of a dermatologist must be a fundamental prerequisite in the design and implementation of all TD programs&#46; All programs and initiatives using ICT to provide dermatologic care must be led by a dermatologist at every stage&#46; The dermatologist must play a coordinating role in multidisciplinary teams developing or using TD&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">All TD programs must include the support of a dermatologist who is available for in-person consultations&#46;</span> TD is complementary to the practice of face-to-face dermatology&#46; It can be used to facilitate triage&#44; prioritization&#44; and patient referral and is in no case a substitute for the availability&#44; when necessary&#44; of an in-person consultation with a dermatologist&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TD should be used to respond to an identified need for improvement in a healthcare process&#46;</span> As a complementary tool for delivering dermatologic care&#44; TD should be integrated into the overall care process to respond to the specific needs identified &#40;accessibility&#44; prioritization&#44; coordination between care levels&#44; follow-up of patients with chronic disease&#44; continuous training&#44; etc&#46;&#41;&#46; It is essential in the design of TD programs to identify the stages and activities in a particular process that are likely to be improved by the use of the methodology&#46; The practice of TD should always be regulated by clearly defined work procedures and referral protocols&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TD must be incorporated into the organization&#39;s portfolio of services&#46;</span> TD activity must be incorporated into the authorized portfolio of services of both the dermatology service providers and other participants &#40;primary care centers&#44; other hospital departments&#41;&#46; All TD activity should be part of a program that is formally recognized and authorized by the relevant hospital&#44; health care center&#44; and&#47;or health authority&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TD programs must be allocated specific and adequate resources to ensure good practice&#46;</span> In the programmed schedule of activities of a dermatology department or clinic&#44; time must be specifically allocated for all of the work involved in a TD program &#40;teleconsultations&#44; training&#44; resolving technical problems&#44; etc&#46;&#41;&#46; All TD programs must use equipment and software designed for the specific purpose to ensure ease of use for those operating the system and secure data transmission&#46; TD applications must be integrated into the corporate information system&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">TD programs must be supported by comprehensive training programs&#46;</span> All professionals participating in a TD program must complete a training program specific to their role&#58; operators &#40;training in obtaining images&#44; user interfaces&#44; etc&#46;&#41;&#44; primary care physicians or other specialist physicians &#40;training in criteria for teleconsultation&#44; referral paths etc&#46;&#41;&#44; dermatologists &#40;training in decision making&#44; the user interface&#44; etc&#46;&#41;&#46; TD training programs must be updated and maintained as long as the program is in operation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The use of TD must be monitored by way of an integrated validation and quality control program&#46;</span> All TD programs must undergo an initial validation process in all the dimensions that will be continuously monitored &#40;efficacy&#44; safety&#44; diagnostic validity&#44; efficiency&#44; and user satisfaction&#41;&#46; Monitoring is also essential to identify errors and deviations from the protocol and to facilitate a quality-control system that will ensure ongoing improvement&#46; AEDV will publish guidelines on clinical practice using TD in order to establish standards for the process and to provide clinical guidelines for dermatologists&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The modality of TD used in each case must be the one that can provide the most efficiency and clinical safety for the specific healthcare need to be met&#46;</span> All the TD methodologies &#40;store-and-forward&#44; real time&#44; mixed&#44; mobile&#41; and modalities of interaction between the participants &#40;primary TD&#44; patient-dermatologist&#59; secondary TD&#44; primary care physician-dermatologist&#59; tertiary&#44; dermatologist-dermatologist&#41; have been shown to have strengths and weaknesses&#46; Physicians should use the method best adapted to the health condition or group of conditions being addressed&#46; Selecting the process in which TD has shown the greatest efficacy is the best guarantee of clinical safety for both patient and dermatologist&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel"><span class="elsevierStyleItalic">10&#46;</span></span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The TD process must respect the patients&#8217; right to choice and ensure their confidentiality at all times&#46;</span> The practice of TD must always include a procedure that defines the purposes and uses of the images obtained and transmitted&#46; All applications used in TD must fulfil the confidentiality and privacy requirements required under current personal data protection legislation<span class="elsevierStyleItalic">&#46;</span> It is advisable to specify the limitations of TD in a safeguard clause&#44; which should be included in all the reports issued by clinicians&#46;</p></li></ul></p></span>"
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