title: Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists.
abstract: BACKGROUND
  Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied.
  
  
  METHODS
  The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California.
  
  
  RESULTS
  Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers.
  
  
  CONCLUSIONS
  Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.
authors.affiliation: Department of Dermatology, University of California Davis School of Medicine, Sacramento, California, United States of America. aprilarmstrong@post.harvard.edu
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.forename: Mei W
authors.initials: MW
authors.lastname: Kwong
authors.forename: Lynda
authors.initials: L
authors.lastname: Ledo
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Shewry
mesh_terms: D003299:Cooperative Behavior; D003710:Demography; D003880:Dermatology / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008962:Models, Theoretical; D009042:Motivation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms / Q000191:economics; D017216:Telemedicine / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce