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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Finding a role for telehealth in coordinated care

Intel Free Press
A doctor consults with a patient using telemedicine.

  Dr. Karen Edison is a dermatologist with the University of Missouri Health system. She has been using telemedicine for over 20 years to see patients at clinics in underserved areas of the state, and to follow-up with her rural patients in their homes. She can see photos of her patient’s skin, answer their questions through email, as well as talk with them through video calling.

Edison says telemedicine is a useful tool because it can save rural patients a trip to her office.

But rural patients aren’t only the ones looking to save time and money.

Ben Holber, co-founder and CEO of YoDerm, saw a dermatologist for his acne when he was a teenager in Monterey, California.

“I missed school, my mom missed work to bring me the 20 minute drive to go see the dermatologist,” Holber said. “[I was] semi-embarrassed as a 16 year old guy who was going to a doctor about my skin and then only seeing her for a couple of minutes.”

So Holber created YoDerm, an online dermatology site that treats acne. Patients upload photos of their skin, answer questions about their acne and fill out a medical history. Then for $59, a dermatologist reviews the information and prescribes a treatment, even calling in a prescription to the patient’s local pharmacy.

And YoDerm isn’t alone. A quick search for  “online dermatologist” reveals several websites, all advertising a flat fee to consult with a dermatologist quickly. This minimal wait time is something many doctors can’t offer their patients in person. A recent survey found the average wait time to see a dermatologist is 29 days. Sites like YoDerm tell patients they can pick up medication in 24 hours.          

However, some doctors like Karen Edison worry about losing the coordination of care as sites like YoDerm become more popular.

“Different doctors and other healthcare providers are going to be giving them medicine without knowing what each other prescribed,” Edison said. “That is a recipe for disaster.”

And people in the telemedicine community understand this. Jonathan Linkous said the technology enhances the resources available to existing providers.

“Telemedicine is a tool. It is not a separate practice of care, it is not a separate speciality, it's a tool just like the use of a stethoscope or an ultrasound,” Linkous said.

And Ben Holber is optimistic online providers like YoDerm will become integrated into a patient’s routine care.

“There are starting to be a lot more integrative tools for making sure that each one of the players around somebody’s health care are able to collaborate and even correspond,” Holber said. "It is going to be interesting how we're going to combine that in-person care with the digital care."

Hope Kirwan left KBIA in September 2015.
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