Telehealth scenario: Teledermatology


The entity (Green Street Dermatology Associates) referenced in this illustrative case is fictional. Individuals, business, events and scenarios referenced are influenced by interviews and review of publicly available literature. Any resemblance to actual individuals, entities or events is purely coincidental.

Green Street Dermatology Associates is a midsize specialty practice that is located in an urban area and conducts about 6,500 visits annually. Green Street recently decided to adopt teledermatology capabilities (eVisits and interprofessional consultations) after patients and primary care practices in the area reported frustration with wait times for nonurgent dermatological consultations.

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The practice is planning to implement eVisits, which enable patients to send a photo of their dermatological condition or complaint directly to their dermatologist through the practice’s online, secure patient portal. The practice’s dermatologists then review the images and provide treatment guidance through a portal message or recommend an in-person visit for further consultation. The practice has hired an interpreter to assist with store and-forward exchanges and ensure that all incoming and outgoing portal communication messages are translated for patients whose first language is not English.

In addition to store-and-forward, the practice has also decided to start providing interprofessional consultations to primary care providers in their network, connecting with them over video to provide live diagnostic support and review pertinent imaging sent by the primary care office.

Green Street Dermatology Associates is adopting teledermatology to:

  • Attract/acquire new patients and retain existing patients.
  • Improve access and timeliness of care by mitigating barriers such as transportation, child care and language.
  • Facilitate appropriate consultation and enhanced referral with local primary care providers.

Clinical outcomes, quality and safety

Clinical quality and safety outcomes

  • Relevant measures
    Improvement in disease detection
  • Impact goals
    Improve detection rate of cancers by 5%

Access to care

Availability of care

  • Relevant measures
    Time to third next available appointment
  • Impact goals
    Reduce wait times to third next available appointment to under two weeks

Patient, family and caregiver experience

Clinical and/or technology experience

  • Relevant measures
    Net Promoter Score (NPS)
  • Impact goals
    Achieve NPS for eVisit service of 50 or higher

Clinician experience

Work experience

  • Relevant measures
    Engagement and satisfaction with work (self-reported)
  • Impact goals
    Increase clinician satisfaction rates by 25% on Green Street’s clinician satisfaction survey

Direct revenue

  • Relevant measures
    Net patient service revenue
  • Impact goals
    Increase net patient service revenue by 5% as a result of new patient growth

Indirect revenue

  • Relevant measures
    Dermatologist panel size
  • Impact goals
    Increase panel sizes by 10%

Health equity

Patient experience

  • Relevant measures
    NPS by language
  • Impact goals
    Achieve no difference in NPS by patient language

University of Connecticut: UConn Health has offered teledermatology since 2015 and covers patients across Connecticut and three clinics of Penobscot Community Health Center in northern Maine.

Kaiser Permanente: The Permanente Medical Group has offered teledermatology to patients in Northern California for over 16 years.

RubiconMD: Founded in 2013, RubiconMD provides a platform to enable interprofessional consults for over 125 specialties, including dermatology.

Clinical outcomes, quality and safety

  • A 2012 study found that teledermatology consultations resulted in a recommendation of initiation or discontinuation of a medication in 67.5% of the cases.
  • Kaiser Permanente found that when dermatologists had the chance to look at well-photographed skin lesions, they were able to identify nearly 10% more cancers with almost 40% fewer referrals to the dermatology department.

Access to care

A 2020 study found that teledermatology led to a 78% reduction in the waiting time for in-person appointments when compared with usual care.

Download the scenario (PDF) and read other Return on Health telehealth case studies and scenarios.

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Using Return on Health to review teledermatology. Read the report and relevant tables.