Dermatology diagnosis goes digital

An arm with a blotchy red rash popped up on Dr. Toby Maurer’s computer screen at San Francisco General Hospital.

The photo, from a physician at a San Mateo County clinic, came with questions: Is this from poison oak, and am I treating it correctly?

Poison oak indeed, Maurer confirmed. She wrote back telling the physician to continue an oral steroid to help knock out the rash.

Maurer, a dermatologist, pulled up another photo of a lesion that wasn’t healing properly. It looked potentially cancerous, and Maurer said the patient should come back for a biopsy.

It probably would have taken weeks for those patients to see a specialist like Maurer as San Mateo County’s 13 clinics struggle with a list of nearly 2,000 patients waiting for a doctor’s appointment.

But Maurer was able to send an answer within 12 hours using the TeleDerm system, a pilot program the county has rapidly expanded to all but one of its clinics since launching it in October in Daly City.

Officials say it will save costs and allow doctors to see more patients.

“It really allowed me to see it very quickly, render advice very quickly,” said Maurer, a UCSF dermatologist.

TeleDerm, which UCSF piloted two years ago with East Bay clinics, allows Peninsula doctors to send digital photos and a patient history through a secure system to computers at San Francisco General, where dermatologists review the case and write back.

“We’ve been planning this for a couple of years and we’re very excited,” said Dr. Susan Ehrlich, the San Mateo Medical Center CEO.

Maurer, who specializes in HIV dermatology, said the idea came after colleagues from rural Africa and China sent her photos of skin ailments asking for advice.

“We’re helping all these people, they have more access to me in rural China than they do in San Mateo. That’s not right,” Maurer said.

The county will still keep a contracted dermatologist available once a week for the 10 percent of patients who need a follow-up after a TeleDerm consult, Ehrlich said.

The TeleDerm program is expected to cost San Mateo County about $112,000 annually, but it will also save about $40,000 per year, Health System spokeswoman Robyn Thaw said.

Maurer said patients seem to like the system, even though they’re no longer seeing a dermatologist in person.

“It has given them access to a specialist, and quick access, “Maurer said.

‘Telemedicine’ usage is not just skin-deep

In addition to dermatology, public health officials are quickly expanding their use of “telemedicine” for psychiatry, ophthalmology and other areas to save cash and serve a growing patient load.

Both San Francisco and San Mateo County are using “teleinterpretation,” allowing a patient and doctor to talk via live videoconference with an interpreter who can translate diagnoses and treatment plans.

Roughly 30 to 40 percent of patients seen by the San Francisco Department of Public Health need some kind of language assistance, said Bruce Occena, the telemedicine coordinator for the department.

For about two years, San Mateo County has also offered a retinal screening program to screen diabetes patients for early signs of diseased blood vessels that can lead to blindness.

Usually, patients have to see an ophthalmologist for such a screening. But the county has three specialized cameras that take photos of a patient’s retinas and send them to an optometrist, who can do an initial screening. The patient is either cleared or sent to an ophthalmologist for further testing.

“You’re using the minimal capacity you have as efficiently as possible,” said San Mateo Medical Center CEO Dr. Susan Ehrlich.

San Francisco hopes to start retinal screening over the next 18 months for its 7,000 diabetic patients, Occena said.

The City is also piloting “telepsychiatry,” which allows primary-care doctors and mental-health professionals to hold a video consult on a patient, Occena said.

Care in the county

San Mateo County has started using TeleDerm to contact dermatology specialists.

5 to 10: Average number of TeleDerm consultations Dr. Toby Maurer does per day
13: San Mateo County clinics; only Menlo Park doesn’t yet have TeleDerm
40: County staff trained to use TeleDerm
50: County patients who have used TeleDerm so far
7,000: Diabetic patients seen by San Francisco Department of Public Health who need annual retinal screenings

Source: San Mateo, San Francisco counties

Correction: This article was corrected on Dec. 22. The original article incorrectly stated facts about the costs associated with the program. The program will save the county about $40,000.

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