- Email: [email protected]
Improving clinical imaging and detection of wrinkles, fine lines, and pigmented spots with a novel, software-driven, open-air, overhead lighting environment
3627
2901
Implementation of Stanford Health Care direct-care teledermatology program Akhilesh Pathipati, Stanford University School of Medicine, Stanford, CA, United States; Justin Ko, MD, MBA, Stanford University School of Medicine, Redwood City, CA, United States
Improving young physician membership and engagement in a dermatology physician organization: The Women’s Dermatology Society as an example Molly Storer, MS, Massachusetts General Hospital, Boston, MA, United States; Arianne Shadi Kourosh, MD, Massachusetts General Hospital, Boston, MA, United States; Kristen Stewart, MD, Kristen M. Stewart, Jacksonville, FL, United States The Women’s Dermatologic Society (WDS) is a nonprofit physician organization that promotes mentorship and service in the dermatology community. WDS leadership noted that membership and engagement of dermatology residents and recent graduates was a particular challenge for the organization. In response, the authors sent all WDS members a survey to identify possible gaps in communication and engagement, particularly for young physicians. Of the 1207 emails that reached a destination (8% attrition due to incorrect email addresses and members who previously opted out of surveys), 616 (51%) responded. Respondents included dermatologists (64%), trainees (31%), dermatology researchers and corporate members (5%). The age distribution showed peaks in the rages of 31-35 years (29%) and 25-30 years (18%), reflecting capture of the target demographics. Of respondents, 30% had not attended a single WDS event in that year, and 79% had not participated in WDS mentorship programs or service programs (88%). Reasons cited for lack of engagement included ‘‘unaware of activities/opportunities’’ (47%) and ‘‘no events in my area’’ (40%). Of respondents, 93% reported owning iPhonecompatible devices, 90% reported using smartphones for professional activities. Over 70% of entire WDS membership and 84% of residents stated they would use a WDS app if one were available, reflecting effect modification for young physicians. Regarding, social media usage, the survey found that Facebook was the most commonly used platform with 75% of members endorsing frequent use (at least weekly 69%, daily or multiple times per day 43%). In response, two of the authors developed a free WDS iPhone app streamlining WDS opportunities and event information onto a mobile platform, and established the WDS Social Media Task Force (SMTF), led by 2 of the authors, in order to expand outreach and communication of the organization on social media (eg, Facebook and YouTube). In its first year, WDS app has been downloaded by 227 users and used 2191 times. The WDS Facebook page, which before the SMTF had \ 200 subscribers, now has [2000 subscribers, and WDS YouTube videos show [500 views. During this time, membership among residents and recent graduates more than tripled (from 282 to 920 members) without changes in other variables. The successful deployment of an app and SMTF by the WDS may serve as a model for other dermatology organizations to improve membership and engagement, especially among young physicians.
Background: Dermatology is well-suited to telemedicine and evidence suggests that teledermatology is an effective means of providing care. However, existing research has largely focused on models in which patients interact with a primary care provider who then refers the patient to a dermatologist. There is now growing interest in patient-initiated, direct-care teledermatology, in which a patient can directly connect with a specialist. Stanford Hospital piloted one of the first directcare teledermatology services to appear in an academic hospital. Methods: Beginning in October 2014, patients enrolled in Stanford Care Alliance Health Plans were given the opportunity to seek remote dermatologic care from Stanford Dermatology. Patients submitted pictures of skin lesions and accompanying information through their online MyHealth accounts. A dermatologist evaluated the patient’s complaint and offered medical guidance through the online system, or asked the patient to come in for an in-person visit if necessary. We analyzed utilization of care, clinical effectiveness, patient satisfaction, and willingness to pay for the service. Results: Between October 2014 and February 2015, 38 patients sought care through the program. A dermatologist was able to make a diagnosis in 36 cases (95%). Patients were an average of 39.3 years old (612.2), and were 84% female. The most common chief complaint was a ‘‘rash’’ (28%), while the second most common was ‘‘acne’’ (19%). A dermatologist was able to make a diagnosis for 36 out of the 38 encounters (95%), with an average confidence level of 7.9/10 (61.8). The average time to initial consultation was 0.8 days (61). The dermatologist was able to manage the patient remotely in 75% of cases, and requested an in-person follow-up visit for 25%. Patient survey results indicate satisfaction with the service. Overall satisfaction was approximately 4/5, and 100% of survey respondents indicated a willingness to pay for the service. Conclusions: Preliminary results suggest that direct-care teledermatology can increase access to dermatologic care without compromising quality in an academic hospital. Additional follow-up is needed regarding patient satisfaction and financial viability. This program may serve as an intellectual foundation and programmatic model for the expansion of telemedicine services to other hospitals and specialties. Commercial support: None identified.
Commercial support: None identified.
3871 Improving clinical imaging and detection of wrinkles, fine lines, and pigmented spots with a novel, software-driven, open-air, overhead lighting environment Ken Budris, Canfield Scientific, Inc, Fairfield, NJ, United States; Scott Kastner, Canfield Scientific, Inc, Fairfield, NJ, United States; William Halas, MS, Canfield Scientific, Inc, Fairfield, NJ, United States; James Joa, The Procter and Gamble Company, Mason, OH, United States; Michael Marmor, The Procter and Gamble Company, Cincinnati, OH, United States; Paul Matts, PhD, The Procter and Gamble Company, Egham, Surrey, United Kingdom; LaShaunda McNeil, PhD, The Procter and Gamble Company, Mason, OH, United States; Joseph Kaczvinsky, PhD, The Procter and Gamble Company, Cincinnati, OH, United States Visualization and measurement of facial skin aging attributes require images captured using specific lighting modes with directional and uniform illumination. Historically, facial skin imaging is accomplished using closed imaging environments for illuminating the subject with uniform diffused lighting, while eliminating unwanted effects of ambient light. However, natural lighting under which a subject’s face is typically perceived is overhead and directional. To fill the unmet need for a portable and application-driven open imaging environment that is optimally tuned for visualization and measurement of facial skin aging attributes, we Imager: An Overhead Lighting Environment (OLE ) imaging system. The present OLE Imager combines a high-resolution digital color camera with applicationOLE controlled Xenon flash sources for standardized facial imaging. The imaging system canopy provides overhead lighting that illuminates the subject’s face with vertical and oblique raked light that mimics natural lighting environment and enhances topographical skin attributes (eg, fine lines, wrinkles, and texture). With no Imager also provides better axis-based polarized secondary reflections, the OLE lighting used for analysis of sub-dermal skin attributes (eg, pigmented spots). Industry standard perspectives of the face (frontal and oblique views) are captured by rotating the canopy around a stationary subject. The software application driving Imager presents a protocol-specific, wizard-driven workflow, and locks all the OLE capture settings on the imaging system to secure repeatable performance for clinical trial imaging. Real-time color and intensity analysis of the captured images ensures the highest level of consistency in image quality. Measurement of facial skin aging attributes is achieved postcapture with an integrated and scripted image analysis application. With a combination of novel design, advanced system control Imager will provide improved application, and image analysis algorithms, the OLE clinical imaging and assessment of facial skin attributes in clinical studies. Studies cosponsored by the Procter and Gamble Company and Canfield Scientific, Inc.
AB106
J AM ACAD DERMATOL
3685 Mobile device use in direct patient care Seth Lofgreen, PharmD, University of Colorado School of Medicine, Aurora, CO, United States; Kurt Ashack, Michigan State University College of Human Medicine, East Lansing, MI, United States; Kyle Burton, University of Central Florida School of Medicine, Orlando, FL, United States; Robert Dellavalle, MD, PhD, Department of Veterans Affairs Medical Center, Denver, CO, United States Eighty percent of clinicians use electronic mobile devices in their daily workflow, and soon the same amount will be using multiple mobile devices. Rapidly evolving technology, improved mobile device optics, and the uniquely visual nature of dermatology all lend themselves to mobile device use in the clinic. This paper examines current literature regarding how dermatologists use mobile device technology in direct patient care. Greater than 350 dermatology apps appeal not only to dermatologists, but also to patients. Most obvious are apps assisting as a clinical reference, but technology continues to increase regarding apps for analysis of pigmented lesions and also for integrating clinical pictures into a patient’s electronic health record (EHR). On the other hand, patients are using mobile apps for documentation of lesions, self-monitoring for changing lesions and even for checking the daily UV index. Furthermore, teledermatology has rapidly increased access to a dermatologist’s expertise in many rural areas. This technology allows closer monitoring of patients who previously had poor access to dermatology while at the same time potentially decreasing healthcare costs. Additionally, residents and students strongly agree that teledermatology is an important part of dermatology training and education. Dermoscopy documentation has previously been limited to a written description, but now improved mobile device optics allow a recorded image which can be used to supplement a teledermatology consult or easily document lesion evolution. However, technological barriers and lack of time may prevent primary care physicians from adopting this technology as a part of teledermatology consults. Additionally, high dynamic range images on mobile devices may improve dermoscopic accuracy when evaluating hypopigmented lesions. Finally, patient perception of mobile device use is often forgotten. While most patients widely accept a hospital-owned digital camera for lesion documentation, significantly fewer are comfortable with a physician using their own private mobile device. Disabling cloud-based storage or using apps that upload directly to an electronic health record may improve patient perception of mobile device use. Dermatology will likely remain an evolving field regarding mobile device use in direct patient care. Commercial support: None identified.
MAY 2016
2901
Implementation of Stanford Health Care direct-care teledermatology program Akhilesh Pathipati, Stanford University School of Medicine, Stanford, CA, United States; Justin Ko, MD, MBA, Stanford University School of Medicine, Redwood City, CA, United States
Improving young physician membership and engagement in a dermatology physician organization: The Women’s Dermatology Society as an example Molly Storer, MS, Massachusetts General Hospital, Boston, MA, United States; Arianne Shadi Kourosh, MD, Massachusetts General Hospital, Boston, MA, United States; Kristen Stewart, MD, Kristen M. Stewart, Jacksonville, FL, United States The Women’s Dermatologic Society (WDS) is a nonprofit physician organization that promotes mentorship and service in the dermatology community. WDS leadership noted that membership and engagement of dermatology residents and recent graduates was a particular challenge for the organization. In response, the authors sent all WDS members a survey to identify possible gaps in communication and engagement, particularly for young physicians. Of the 1207 emails that reached a destination (8% attrition due to incorrect email addresses and members who previously opted out of surveys), 616 (51%) responded. Respondents included dermatologists (64%), trainees (31%), dermatology researchers and corporate members (5%). The age distribution showed peaks in the rages of 31-35 years (29%) and 25-30 years (18%), reflecting capture of the target demographics. Of respondents, 30% had not attended a single WDS event in that year, and 79% had not participated in WDS mentorship programs or service programs (88%). Reasons cited for lack of engagement included ‘‘unaware of activities/opportunities’’ (47%) and ‘‘no events in my area’’ (40%). Of respondents, 93% reported owning iPhonecompatible devices, 90% reported using smartphones for professional activities. Over 70% of entire WDS membership and 84% of residents stated they would use a WDS app if one were available, reflecting effect modification for young physicians. Regarding, social media usage, the survey found that Facebook was the most commonly used platform with 75% of members endorsing frequent use (at least weekly 69%, daily or multiple times per day 43%). In response, two of the authors developed a free WDS iPhone app streamlining WDS opportunities and event information onto a mobile platform, and established the WDS Social Media Task Force (SMTF), led by 2 of the authors, in order to expand outreach and communication of the organization on social media (eg, Facebook and YouTube). In its first year, WDS app has been downloaded by 227 users and used 2191 times. The WDS Facebook page, which before the SMTF had \ 200 subscribers, now has [2000 subscribers, and WDS YouTube videos show [500 views. During this time, membership among residents and recent graduates more than tripled (from 282 to 920 members) without changes in other variables. The successful deployment of an app and SMTF by the WDS may serve as a model for other dermatology organizations to improve membership and engagement, especially among young physicians.
Background: Dermatology is well-suited to telemedicine and evidence suggests that teledermatology is an effective means of providing care. However, existing research has largely focused on models in which patients interact with a primary care provider who then refers the patient to a dermatologist. There is now growing interest in patient-initiated, direct-care teledermatology, in which a patient can directly connect with a specialist. Stanford Hospital piloted one of the first directcare teledermatology services to appear in an academic hospital. Methods: Beginning in October 2014, patients enrolled in Stanford Care Alliance Health Plans were given the opportunity to seek remote dermatologic care from Stanford Dermatology. Patients submitted pictures of skin lesions and accompanying information through their online MyHealth accounts. A dermatologist evaluated the patient’s complaint and offered medical guidance through the online system, or asked the patient to come in for an in-person visit if necessary. We analyzed utilization of care, clinical effectiveness, patient satisfaction, and willingness to pay for the service. Results: Between October 2014 and February 2015, 38 patients sought care through the program. A dermatologist was able to make a diagnosis in 36 cases (95%). Patients were an average of 39.3 years old (612.2), and were 84% female. The most common chief complaint was a ‘‘rash’’ (28%), while the second most common was ‘‘acne’’ (19%). A dermatologist was able to make a diagnosis for 36 out of the 38 encounters (95%), with an average confidence level of 7.9/10 (61.8). The average time to initial consultation was 0.8 days (61). The dermatologist was able to manage the patient remotely in 75% of cases, and requested an in-person follow-up visit for 25%. Patient survey results indicate satisfaction with the service. Overall satisfaction was approximately 4/5, and 100% of survey respondents indicated a willingness to pay for the service. Conclusions: Preliminary results suggest that direct-care teledermatology can increase access to dermatologic care without compromising quality in an academic hospital. Additional follow-up is needed regarding patient satisfaction and financial viability. This program may serve as an intellectual foundation and programmatic model for the expansion of telemedicine services to other hospitals and specialties. Commercial support: None identified.
Commercial support: None identified.
3871 Improving clinical imaging and detection of wrinkles, fine lines, and pigmented spots with a novel, software-driven, open-air, overhead lighting environment Ken Budris, Canfield Scientific, Inc, Fairfield, NJ, United States; Scott Kastner, Canfield Scientific, Inc, Fairfield, NJ, United States; William Halas, MS, Canfield Scientific, Inc, Fairfield, NJ, United States; James Joa, The Procter and Gamble Company, Mason, OH, United States; Michael Marmor, The Procter and Gamble Company, Cincinnati, OH, United States; Paul Matts, PhD, The Procter and Gamble Company, Egham, Surrey, United Kingdom; LaShaunda McNeil, PhD, The Procter and Gamble Company, Mason, OH, United States; Joseph Kaczvinsky, PhD, The Procter and Gamble Company, Cincinnati, OH, United States Visualization and measurement of facial skin aging attributes require images captured using specific lighting modes with directional and uniform illumination. Historically, facial skin imaging is accomplished using closed imaging environments for illuminating the subject with uniform diffused lighting, while eliminating unwanted effects of ambient light. However, natural lighting under which a subject’s face is typically perceived is overhead and directional. To fill the unmet need for a portable and application-driven open imaging environment that is optimally tuned for visualization and measurement of facial skin aging attributes, we Imager: An Overhead Lighting Environment (OLE ) imaging system. The present OLE Imager combines a high-resolution digital color camera with applicationOLE controlled Xenon flash sources for standardized facial imaging. The imaging system canopy provides overhead lighting that illuminates the subject’s face with vertical and oblique raked light that mimics natural lighting environment and enhances topographical skin attributes (eg, fine lines, wrinkles, and texture). With no Imager also provides better axis-based polarized secondary reflections, the OLE lighting used for analysis of sub-dermal skin attributes (eg, pigmented spots). Industry standard perspectives of the face (frontal and oblique views) are captured by rotating the canopy around a stationary subject. The software application driving Imager presents a protocol-specific, wizard-driven workflow, and locks all the OLE capture settings on the imaging system to secure repeatable performance for clinical trial imaging. Real-time color and intensity analysis of the captured images ensures the highest level of consistency in image quality. Measurement of facial skin aging attributes is achieved postcapture with an integrated and scripted image analysis application. With a combination of novel design, advanced system control Imager will provide improved application, and image analysis algorithms, the OLE clinical imaging and assessment of facial skin attributes in clinical studies. Studies cosponsored by the Procter and Gamble Company and Canfield Scientific, Inc.
AB106
J AM ACAD DERMATOL
3685 Mobile device use in direct patient care Seth Lofgreen, PharmD, University of Colorado School of Medicine, Aurora, CO, United States; Kurt Ashack, Michigan State University College of Human Medicine, East Lansing, MI, United States; Kyle Burton, University of Central Florida School of Medicine, Orlando, FL, United States; Robert Dellavalle, MD, PhD, Department of Veterans Affairs Medical Center, Denver, CO, United States Eighty percent of clinicians use electronic mobile devices in their daily workflow, and soon the same amount will be using multiple mobile devices. Rapidly evolving technology, improved mobile device optics, and the uniquely visual nature of dermatology all lend themselves to mobile device use in the clinic. This paper examines current literature regarding how dermatologists use mobile device technology in direct patient care. Greater than 350 dermatology apps appeal not only to dermatologists, but also to patients. Most obvious are apps assisting as a clinical reference, but technology continues to increase regarding apps for analysis of pigmented lesions and also for integrating clinical pictures into a patient’s electronic health record (EHR). On the other hand, patients are using mobile apps for documentation of lesions, self-monitoring for changing lesions and even for checking the daily UV index. Furthermore, teledermatology has rapidly increased access to a dermatologist’s expertise in many rural areas. This technology allows closer monitoring of patients who previously had poor access to dermatology while at the same time potentially decreasing healthcare costs. Additionally, residents and students strongly agree that teledermatology is an important part of dermatology training and education. Dermoscopy documentation has previously been limited to a written description, but now improved mobile device optics allow a recorded image which can be used to supplement a teledermatology consult or easily document lesion evolution. However, technological barriers and lack of time may prevent primary care physicians from adopting this technology as a part of teledermatology consults. Additionally, high dynamic range images on mobile devices may improve dermoscopic accuracy when evaluating hypopigmented lesions. Finally, patient perception of mobile device use is often forgotten. While most patients widely accept a hospital-owned digital camera for lesion documentation, significantly fewer are comfortable with a physician using their own private mobile device. Disabling cloud-based storage or using apps that upload directly to an electronic health record may improve patient perception of mobile device use. Dermatology will likely remain an evolving field regarding mobile device use in direct patient care. Commercial support: None identified.
MAY 2016