Telederm Australia

Abstract

A doctor using a teledermatology service needs more skills than one utilising a traditional face-to-face referral. Doctors using a telemedicine service face a greater burden of responsibility and an increased workload than with a traditional referral. A viable teledermatology service must offer online education alongside its consultation service. Telemedicine is an efficient and cost-effective solution to the lack of dermatological services. Appropriate remuneration for referring doctors is vital if telemedicine is to become widely adopted.

Appendices

Appendix 4.1. Submit a Case to Tele-Derm

Acknowledgement and Disclaimer

Before using the TELE-DERM service you must agree to the following terms:

• 1. I am a doctor registered to practice in Australia and hold current medical indemnity insurance.

• 2. I acknowledge that the TELE - DERM service is intended to assist me in diagnosing and managing my patient’s condition. A consultation with a TELE - DERM dermatologist is not a substitute for my clinical judgement. I continue to be responsible at all times for the diagnosis and management of my patient’s condition.

• 3. I acknowledge that there is less margin for error in a face to face consultation compared with an internet consultation such as the TELE - DERM service.

• 4. I have written confirmation from my medical indemnity insurer that the existing policy of medical indemnity insurance issued to me covers my use of the TELE - DERM service.

• 5. I have obtained my patient’s informed consent to using the TELE - DERM service. In doing so, I explained to my patient that I would be using the internet to consult a TELE - DERM dermatologist on the patient’s condition but that all decisions regarding diagnosis and management would be made by me. I also explained to my patient that the consultation would necessitate e-mailing information and images relating to my patient’s condition and that there could be an increased potential for unauthorised disclosure or error in diagnosis or management arising from use of an internet service as compared to a face to face consultation. As an alternative, I offered my patient referral to a dermatologist.

• 6. Unless specifically indicated by me, my patient has also given informed consent to his or her case being posted on the TELE - DERM website for educational purposes. My patient was made aware that this is not a condition to my using the TELE - DERM service.

• 7. My patient has signed the TELE - DERM consent form. I have included this in my patient record.

• 8. I will not include in any material submitted to a TELE - DERM dermatologist any information from which my patient could be identified. In particular no names, addresses or dates of birth will be included. The images of the condition submitted are such that the patient cannot be identified by his or her physical features.

• 9. I acknowledge that the TELE-DERM service is hosted by the Australian College of Rural and Remote Medicine (“ACRRMquot”) and funded by the Commonwealth Government as represented by its Department of Health and Ageing, with the fundholder being Queensland Divisions of General Practice. The Department and ACRRM, and their respective directors and other officers and emp­loyees, partners, agents and sub-contractors make no representations or warranties and do not accept any liability from any person for the information or guidance (or the use of such information or guidance) which is provided on the TELE-DERM web site or as part of the TELE-DERM service.

• 10. Although every effort is made by ACRRM and its contractors to ensure the integrity of TELE-DERM web site, ACRRM cannot guarantee the safety of computer systems of site users. ACRRM does not accept liability for any damage to any computer system which has been connected to the TELE - DERM web site. Users enter the web site at their own risk.

Appendix 4.2. Patient Consent Form for Use of TELE-DERM Service

I ……………………….., acknowledge that my doctor is seeking information and guidance on the diagnosis and management of my condition from a qualified dermatologist at TELE–DERM. This involves transmission of details of my case, including images over the internet. I have checked with my doctor that no details or images sent can reveal my identity. I acknowledge that the internet is not a totally secure medium and third parties may be able to gain unauthorized access to my TELE-DERM consultation. I realize that a face to face consultation with a dermatologist is less likely to result in an error of diagnosis or management.

I understand that I can instead be referred to a dermatologist for a face to face consultation if I wish.

I understand that dermatologists at TELE–DERM are merely giving my doctor information and guidance. They will not be responsible for the diagnosis and management of my condition.

I understand that all decisions on the diagnosis and management of my condition will be made by my doctor, [insert referring doctor’s name].

I understand that I may still need to see a dermatologist face to face if my condition cannot be managed by my doctor after consultation with a TELE–DERM dermatologist.

I consent to my case being posted on the TELE – DERM web site for educational purposes. [Delete if consent not given].

I acknowledge that the TELE-DERM service is hosted by the Australian College of Rural and Remote Medicine (“ACRRM”) and funded by the Commonwealth Government as represented by its Department of Health and Ageing. The Department and ACRRM, and their respective directors and other officers and employees, partners, agents and sub-contractors make no representations or warranties and do not accept any liability from any person for the information or guidance (or the use of such information or guidance) which is provided on the TELE-DERM web site or as part of the TELE-DERM service

This Consent may be relied upon by the Doctor, Queensland Division of General Practice, the TELE – DERM dermatologists, the Commonwealth Government and ACRRM (including their directors and other persons mentioned above).

Signed……………Date ………………………….

Witness…………………. [referring doctor]