In addition to core recommendations, the guide also includes supporting notes covering their application in a clinical setting.
A major update to Australia’s dermatology telehealth standards is set to reshape how virtual skin consultations are delivered, with stricter requirements for image quality, record-keeping and patient consent.
The guideline, published last week in the Australasian Journal of Dermatology, also highlights patient selection and choosing a suitable modality, and recommended consideration of a blended model of care, combining both in-person and virtual appointments.
Selecting patients who are suitable for telehealth should be on a case-by-case basis, and the limitations of remote diagnosis should be addressed.
Informed consent, where a patient has been advised of the purpose, risks, and limitations of teledermatology, needs to be gained.
Video consults need to have sufficient video quality to properly assess dermatological issues, and phone consults are only recommended when visual information isn’t needed or is available as photos or videos.
Guidance for choosing a videoconferencing platform, optimising screen and camera settings as well as the physical environment have been included in the update.
Store-and-forward teledermatology may only to be used for patients if images have been taken by a person trained in the use of a dermatoscope and are included with the referral.
All images are considered part of a patients’ medical record, so must be securely stored in accordance with state and territory legislation. This typically requires retention for seven years, though this may be longer for children.
Any images captured on mobile devices should adhere to AMA clinical image guidelines. Additional notes in the teledermatology guide outline how to best capture images, including camera settings, photography technique and reviewing images.
The guideline made note of the option to provide referrers with guidelines or aids for taking quality images, and dermatologists were encouraged to provide feedback to the referrer about the quality of information and imaging they provided.
A teledermatology appointment is unlikely to be appropriate if referral information is inadequate.
If a patient is referred for an individual lesion but the dermatologist believes a full skin examination is warranted, managing the individual lesion (by utilising telehealth if necessary) should be the priority, and a full skin examination should be organised when feasible.
The use of reliable technology, platforms and data services were highlighted in the guideline, to ensure safe and effective consultations while protecting patient confidentiality.
Documentation needs to be maintained in the same way as for face-to-face appointments but include whether the consult was conducted by video conference or telephone, the names of all attendees and sites and any technical difficulties experienced during.
The guideline endorses the wording recommended by the American Telemedicine Association: “Based on the images and history provided, my impression is as follows.”
Both the dermatologist and the clinician at the patient’s end are expected to record details of the consultation.
The Medical Board of Australia’s guidelines for telehealth consultations apply to teledermatology, requiring clinicians to make their identity known to the patient, confirm the identity of the patient at each consultation and ensure anyone attending or within earshot are either on screen or identified.
Clinicians were reminded to take all necessary steps to ensure health record privacy and report any data breaches that are likely to result in harm.
It should not be routine practice to record and store teleconsultations, and additional patient consent is required to record. The guideline does not include mention of AI scribes.
Proficiency in interpreting images is emphasised as a key component of delivering telehealth, especially if using advanced imaging techniques such as dermoscopy, reflectance confocal microscopy, optical coherence tomography and total body photography.
The guideline has been restructured from the first 2020 iteration to align with the Medical Board of Australia’s revised guidelines for technology-based consultations and associated AHPRA guidance.
It was developed by the University of Queensland’s Centre for Online Health in collaboration with the Australasian College of Dermatologists’ Digital Health Committee and has been approved by the Australasian College of Dermatologists.
