SPOTLIGHT ON Picturing Innovation Yamhill CCO uses common technology for increased specialty care access “NECESSITY IS THE MOTHER OF INVENTION” was reportedly first coined in Plato’s Republic. Some sentiments are equally true, whether they are applied in the Greece of the third century BCE, or in McMinville in 2016. While working as the Yamhill Community Care Organization’s Health Strategy Officer, the community recognized an opportunity to improve access to dermatology care for the local Medicaid population using a common device that most carry with them. The idea was simple, to use a smart phone to take a picture of a skin problem, then email the photo to a dermatologist. The specialist makes a diagnosis and formulates a treatment plan, which is sent back to the patient. Simple and effective…and it got me thinking. Worth a thousand words While working for the Yamhill CCO, I was also participating in the Oregon Health Authority’s Council of Clinical Innovators (CCI) program, which supported various professionals across the state in developing and implementing innovative models of care. I wondered: could we take the simple idea of patients sending photos to a dermatologist and operationalize it to make it a formal part of the care delivery system? CCI was eager to answer the question, and provided a small stipend I used to purchase iPads, the technical foundation of the program. As a radiologist, I had experience with the tele-radiology model, and knew of nationwide companies with secure platforms to facilitate transferring imaging exams to radiologists. I knew that similar platforms now exist in dermatology, and identified a nationwide tele-dermatology provider interested in working with us. Next I worked with primary care providers to place the iPads in their clinics. Now with a device and virtual dermatology network in place, if a patient came to see their provider with a skin issue that needed attention from a specialist, the clinic could help facilitate a consult simply by picking up a tablet. Providers can quickly log into the tele-dermatology app, take a photo of the patient’s insurance card and skin condition, answer a few brief clinical questions, then receive a diagnosis and recommended treatment back, all within 24 hours. A photo finish The results of the technology expansion speak for themselves. Patients benefit from more ready access to care without needing to travel out of the area. Twelve clinics initially received iPads, and practitioners have performed over 100 teledermatology consults thus far. Billing codes have been identified for the dermatologist to use for their work, as well as for the clinic to bill in helping to facilitate consults. The program demonstrates how a care team can be supported and expanded with simple, affordable technology, familiar to nearly everyone. The tablet program also builds on existing care delivery pathways in clinics. In the first clinic to adopt the model, for instance, an in-house radiology x-ray technician adopted the additional role of “teledermatology tech,” essentially serving as the go-to staff member to take photos with the iPad and to help facilitate the consult. Jim Rickards MD, MBA Chief Medical Officer Oregon Health Authority 26 Medicine in Oregon www.theOMA.org
OMA Medicine in OR Spring 2016
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