Teledermatology still performed outside the framework and poorly remunerated by health insurance (SFD)

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The "teledermatology & e-health" group of the learned society wanted to carry out an inventory of teledermatology and draw up a profile of teledermatologists in France in 2019.

For this, a questionnaire was sent with the SFD newsletter from April to June 2019. Only the responses of dermatologists declaring to practice a teledermatology activity within the framework of a secure and formalized network were analyzed, indicate Dr Mathieu Battle of the CH of the Saint-Omer region (Pas-com-Calais) and his colleagues in the summary of their communication.

In total, 362 responses were collected and only 18% said they had a telemedicine activity in a formal setting, 13% had a telemedicine project and 55% had an informal practice outside the framework.

Among the 68 dermatologists with supervised telemedicine activity, 65% were women, over 45 years (76%), 57% were self-employed and 28% were in public or military hospital practice (15% other) and 48 % had been doing telemedicine for less than two years.

These dermatologists mainly carry out tele-expertises (83%) and 35% also carry out teleconsultations. They give 1 to 5 reviews per week (75%), on their working day in addition to the usual activities (66%) and / or outside (41%) but only 20% plan a specific niche for this activity.

60% use a regional public platform, 32% a private platform and 27% secure email. The vast majority use a business computer (80%), about a third (34%) their mobile phone or personal computer (31%).

Financial aid for two-thirds

The establishment of the teledermatology activity was helped financially for 65% of the doctors, including 79% by regional health agencies (ARS), 15% by regional unions of liberal health professionals (URPS) and 33% from other sources.

Two-thirds of telemedicine acts are remunerated and, in this case, by health insurance only for 12%.

More than half (55%) declared a perennial activity, 29% in the course of experimentation and for 3%, it was in danger (27%, others). They were 15% applying a CS tariff (specialist consultation) and / or 22% the APC tariff (ad hoc consultant opinion). In 19%, an inter-establishment service was applied and in 43%, it was an even different remuneration.

Doctors mainly respond to requests from accommodation establishments for dependent elderly people (Ehpad) (48%) or general practitioners (48%), but also from hospitals and especially emergency rooms (23%), penitentiary centers (18 %) and the patients themselves (14%).

The reasons concerned general dermatology (74%), skin tumors (74%), chronic wounds (55%), emergencies (30%).

If necessary, half of the teledermatologists had planned a post-telemedicine face-to-face consultation. This consultation was then mainly done by the teledermatologist himself (79%), sometimes the patient could be referred to a close colleague (32%) or a hospital (27%) within the framework of a care chain.

45% of them followed up with telemedicine.

The majority of teledermatology notices in France are still given outside the box. The volume of acts still appears low in a secure and formalized framework and practices are heterogeneous. Some teledermatologists are not remunerated, few charge their fees for health insurance and not all are organized to provide post-telemedicine care, comment the authors.

Certain telemedicine acts have entered into common law, opening the reimbursement by health insurance of teleconsultation acts in September 2018 and tele-expertise in February 2019, first to certain patients before considering extending to all by the end of 2020, we recall.

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