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- Presentation
Scaling Teledermatology at Kaiser Permanente: From Expansion to Excellence
Description
Veena Vanchinathan described how Kaiser Permanente Northern California scaled teledermatology into a high-volume, integrated service that supports a 4.5 million-member population with 140 dermatologists and thousands of physicians across the system. Teledermatology cases can originate from patient-secure messages, primary care visits with dermoscopy images, or dermatologist-to-dermatologist consultations, and are handled through both asynchronous store-and-forward and synchronous live video/phone-supported workflows. All cases are read by board-certified dermatologists and documented in the EMR using a standardized dot phrase that captures image type, photo quality, reason for consult, and outcome. The program, launched in 2011 and strategically expanded in 2017, now handles over 350,000 cases annually, with roughly 67% managed by immediate advice and about one-third referred for in-person specialist care; urgent cases are typically reviewed within 30 minutes. Lesion consults make up the largest share of volume, aided by PCP dermoscopy training, while rash consults are also common and often resolved without in-person visits. Key quality metrics include maintaining inadequate photo rates around 4% to 5%, improving patient and clinician photo-taking guidance, simplifying history collection, reducing documentation burden with templates, and using clear patient-friendly communication about how teledermatology works. The speaker emphasized that teledermatology can improve cancer detection, reduce wait times, cut unnecessary biopsies and clinic visits, and help optimize access and patient time. Future process changes will move telederm into an order-based workflow with more standardized intake and likely greater efficiency.
View moreConclusions
- Teledermatology can be successfully deployed at very large scale when it is embedded in routine primary care workflows, supported by trained dermatologists, and backed by standardized documentation and triage processes.
- In this Kaiser Permanente model, about two-thirds of teledermatology cases are managed with immediate virtual advice, while about one-third still require an in-person dermatology visit.
- High-volume teledermatology can achieve rapid turnaround, with urgent cases often answered within 30 minutes and standard cases within one to two business days or faster.
- Image quality is generally good enough for efficient care, but poor or inadequate photos remain a meaningful quality metric that tends to hover around the 4% to 5% range.
- Teledermatology is especially effective for rash evaluations, where return-to-dermatology rates are lower and many conditions can be managed from clear photos alone.
- Lesion-related consults make up a very large share of teledermatology demand and have higher follow-up visit rates, reflecting the need for careful cancer-risk triage.
- Dermoscopy and clinician training appear to improve lesion assessment, helping teledermatology detect skin cancer well while reducing unnecessary biopsies and face-to-face visits.
- The program’s success depends heavily on robust systems, clinician readiness, effective triage, and a strong video platform for select interactive cases.
- Improving patient photo-taking guidance and simplifying history questionnaires are key ways to reduce inadequate submissions and improve diagnostic usefulness.
- Standardized templates, patient-friendly language, and clear ownership of patient communication reduce documentation burden and make the workflow more scalable.
- The overall findings suggest that teledermatology can expand access without overwhelming specialty clinics if the program is carefully structured to preserve quality and prioritize higher-risk cases.
- Upcoming workflow changes that shift teledermatology into an order-based intake system are expected to further standardize data collection and improve efficiency.
- Marwaha S, Dusendang JR, Alexeeff SE, et al. Rash management in a community-based health system: a retrospective cohort study of teledermatology e-consults. Journal of the American Academy of Dermatology, 2023.#10.7812/tpp/20.035
- Marwaha S, Pham C, Tuerk MJ, et al. Rash presentation in a community-based health system: a retrospective cohort study of teledermatology e-consults. Journal of the American Academy of Dermatology, 2023.
- Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer. Journal of the American Academy of Dermatology. Nov 2019;81(5).#10.1016/j.jaad.2019.01.067