“There are some things we do in our professional careers that ultimately become our legacies. After I retire, I hope that this program will be ongoing, making the practices of our physicians better and helping our patients get great care.”
Confronted with high referral rates and significant access challenges, Drs. Kass and Crowley teamed up in 2006 to identify ways to improve efficiency and enhance care delivery.
One medical center, San Francisco, had one-third fewer referrals than the rest of the region — thanks to their Roving Dermatology Program, in which a dermatologist is on call every weekday to see patients in the primary care physician's exam room. This model is practical when all of the primary care physicians (PCPs) are located in the same building and there is an adequate supply of dermatologists.
Undaunted by the fact that most facilities couldn't replicate this model, Drs. Crowley and Kass envisioned a way to use technology to create a virtual roving dermatology program, now known as Teledermatology. Instead of the dermatologist going to the exam room, a medical assistant uses a digital camera (sometimes fitted with a dermatoscope) to create an image of the patient's skin condition, which is uploaded to KP HealthConnect for remote viewing and response by the teledermatologist — usually within 30 minutes.
Based on the success of pilot projects at five different facilities, regionwide rollout Napa/Solano of the Teledermatology Program began in 2009. While some facilities chose to keep onsite roving dermatologists, the majority of facilities are now using teledermatology exclusively.
"Teledermatology helps primary care doctors take care of certain conditions, so patients who need a dermatologist's expertise can get it quickly," notes Dr. Crowley. Currently about 70% of members get their skin care issues addressed during their visit with their PCP; other patients leave with a Dermatology appointment scheduled within a week, and many times on the same day. Improvement was so dramatic that Dermatology quickly went from having some of the worst access in the region to having some of the best same-day access of any specialty.
"By providing very rapid access to dermatologist expertise, we have been able to make diagnoses, like disseminated herpes zoster and melanoma, fast enough to have a tremendous impact on the patient's life," notes Dr. Kass. "We probably have even saved some lives."