Vol. 24 Annals of Health Law 326
patients with psychiatric services located in a metropolitan area. 377 Another
example of PAs taking an active role in the utilization of this technology is
in the application of teledermatology, which utilizes “the remote delivery of
dermatologic services and clinical information using telecommunications
technology.” 378 Two forms of teledermatology are commonly used. The
first, called store-and-forward (“SAF”), uses asynchronous still digital image technology for communication, similar to e-mail. 379 In this approach,
participants are typically separated by both time and space. 380 In the second,
termed “real-time” or “live-interactive video-conferencing,” audio-visual
technology is used and participants are separated by space, but not by
time. 381
This application has become particularly important for patients in rural
areas where even the most convenient and accessible dermatology practice
may be in excess of hundreds of miles. This distance frequently results in
treatment delays that can put patients at increased risk. 382 Geisinger Health
System in Northeastern and Central Pennsylvania utilizes PAs in teledermatology so that rural patients in Pennsylvania can have better access to der-
377. Id.
378. Teledermatology, AM. ACAD. OF DERMATOLOGY, https://www.aad.org/members/
practice-and-advocacy-resource-center/practice-arrangements-and-operations/teled
ermatology (last visited Nov. 16, 2014) (defining teledermatology). See also Sharon Rounds,
Innovative Approaches to Healthcare Delivery at the Providence VA Medical Center, 93
MED. & HEALTH R. I. 6, 6-7 (2010) (discussing PA utilization of teledermatology in the Dermatology Section of the Providence VA Medical Center and provision of teledermatology
services to VA facilities in rural Maine.).
379. Teledermatology, AM. ACAD. OF DERMATOLOGY, https://www.aad.org/
members/practice-and-advocacy-resource-center/practice-arrangements-and-operations/teledermatology (last visited Nov. 16, 2014); See also AM. TELEMEDICINE ASS’N. ,
STATE MEDICAID BEST PRACTICE STORE-AND-FORWARD TELEMEDICINE (2013) (“
Store-and-forward telemedicine refers to the use of asynchronous [not real-time] computer-based
communication between a patient to a consulting provider [referred to as “
Direct-to-Consumer”], or a referring healthcare provider and a medical specialist [referred to as “
Pro-vider-to-Provider”] at a distant site for the purpose of diagnostic and therapeutic assistance
in the care of patients who otherwise have no timely access to specialty care. The use of
asynchronous transmissions is common for some specialties such as radiology and pathology. However, other medical specialties such as dermatology and ophthalmology that can effectively and economically utilize store and forward telemedicine to improve patient access
and quality of care are often not covered for Medicaid reimbursement.”).
380. Id.
381. Id.
382. Karyn B. Stitzenberg et al, Distance to Diagnosing Provider as a Measure of Access to Patients with Melanoma, 143 ARCHIVES OF DERMATOLOGY 991, 997 (2007), available at http://archderm.jamanetwork.com/article.aspx?articleid=654325&resultClick=3. The
farther that patients travel to reach their diagnosing providers, the more advanced their stage
at diagnosis is likely to be. Although we do not yet have survival data, it is reasonable to
surmise that differences in Breslow thickness at diagnosis could translate into differences in
overall survival.
