Norman Brunette, 49, of West Warwick, was miserable; he'd suffered for years with severe and widespread psoriasis over much of his body.
Eventually, he sought help from Thundermist Health Center, in West Warwick, which is piloting an electronic dermatology consultation program with Community E-Consult Network, a subsidiary of Community Health Center Inc., in Middletown, Conn.
Within days of visiting Michelle Blade Mello, a Thundermist family nurse practitioner and certified nurse midwife, Brunette began experiencing relief, thanks to a steroid cream she prescribed.
With no dermatologists on staff, Thundermist launched the pilot in September 2016, after witnessing the lengthy delays patients endured to see a dermatologist. A nurse at the health center takes a series of pictures of the patient's skin condition with a digital camera, and downloads them to the patient's emergency medical record. Then, Thundermist's referral coordinator forwards the photographs and the physician's notes to Community E-Consult Network, which contracts with a dermatologist to provide a second opinion. Within two or three business days, Thundermist receives the dermatologist's detailed consultation notes, which provide guidance to the physician and become part of the patient's medical records.
This approach, said Blade Mello, "really helps us to start treatment a lot faster. I can start treatment in two or three days. It's so much better [and offers] increased access to care. Normally, a dermatology consult takes three to four months just to get an appointment."
Although neither Thundermist nor CHC would disclose the cost of the e-consults, Dr. Daren Anderson, CHC vice president/chief quality officer, said "it is orders of magnitude cheaper than going to a dermatologist … for the entire health care system. [There's] no missed productivity or added costs of additional testing and duplication of labs, etc."
Asked why more primary care providers don't use dermatology e-consults, Blade Mello said, "I think they don't know about it; if they knew about it, they'd be happy to do this." She acknowledged, however, that barriers exist, including insurance reimbursements and constraints on physicians' time to research such options.
Until there is consensus on who should pay for e-consults, enrollment will be spotty, acknowledged Anderson. While his organization provides training to those photographing a patient, the e-consult system allows doctors to continue doing business as usual.
UnitedHealthcare of New England Inc. pays for the e-consult program for its Medicaid patients, and Jessie B. Cox Charitable Trust grant funds cover those costs for other patients. Neighborhood Health Plan of Rhode Island's insureds will soon be covered for Thundermist's dermatology e-services, said Dr. Francisco "Paco" Trilla, NHPRI's chief medical officer.
Neither Blackstone Valley Community Health Care nor the Comprehensive Community Action Program has initiated e-consults. At Providence Community Health Centers, Dr. Andrew Saal, vice president, chief medical officer, indicated that PCHC is considering telehealth.
Telehealth, or e-consult, initiatives are not confined to dermatology consultations. NHPRI's Health@Home program effectively uses telehealth-related technologies, reported Trilla. When NHPRI's community-health workers make house calls to the insurer's members, they may take photos or short videos when medical questions arise. The community-health worker then securely sends those images to NHPRI, where a doctor evaluates and responds to the issue.
Blue Cross & Blue Shield of Rhode Island offers primary care telemedicine services for its commercial insureds, who can speak with a doctor around the clock, through the telemedicine video and chat service, said Jill Flaxington, a Blue Cross public affairs specialist. With approximately half of online telemedicine contacts occurring during working hours – when employees would otherwise have to take time out of the office for medical appointments – employers benefit, too, Flaxington said.
Thundermist of West Warwick has had approximately three dozen e-consults. It plans to expand dermatology e-consults to its Woonsocket and South County locales after fully evaluating the program, and to initiate a cardiology e-consult program. •