By John Dobak, M.D., CEO of DermTech
The healthcare industry has taken enormous leaps in recent years as innovations like telehealth and in-home diagnostic testing have emerged, increasing accessibility to healthcare and convenience for patients. Telehealth has made it possible for patients to receive care without an in-person office visit and in-home diagnostic testing, which can be conducted via telehealth under the supervision of a licensed provider, can now be leveraged to learn more about a patient’s health to help determine actionable next steps.
Before the pandemic, developments in telehealth were moving at a steady, but slow pace. The emergence of COVID-19 disrupted the traditional healthcare model and accelerated the delivery of healthcare in the home. Emergency use authorizations by Medicare and other payors reduced restrictions that hindered delivery of telemedicine solutions, including the allowance of virtual medical services to be delivered from nearly any setting and with any technology solution such as a smartphone or Zoom conferencing. Equally important, these services were paid for at the same rate as an office visit and used the same billing codes, encouraging medical professionals to expand their telemedicine usage. If the sweeping emergency authorizations become permanent through legislation, it is likely we will see continued expansion and advancement of virtual care delivery.
The current paradigm for virtual care delivery primarily addresses health conditions that can be diagnosed via a simple consultation and prescription treatment. Further advancement will require more comprehensive in-home diagnostic assessments and treatment options. A new wave of investment and innovation in telehealth will center on in-home diagnostic testing, and in some cases solving problems related to home tissue sample collection needed for diagnostic testing.
Focus on Skin Health and Access to Dermatologic Care
Teledermatology is one of the more rapidly expanding applications of telemedicine. Skin conditions are primary assessed through a visual assessment and are hence addressable by virtual care visits that employ video or store and forward photographic images. Today, there is massive demand around skincare and skin health from the patient side – likely because our skin is constantly visible and top-of-mind for us. In fact, almost half of all visits to the doctor include a skin complaint. When it comes to skin, we are responding to something that we see every day, rather than an internal issue that is less conspicuous.
Despite the public’s focus on skin, data shows that less than 10% of people see a dermatologist regularly. While several factors attribute to these low rates, the current dermatologist shortage and scheduling delays can make it more difficult for patients to consult their doctor in a timely manner. In fact, it’s not unusual for patients to have to wait three to four months to see a dermatologist. The lack of easy access to dermatological care is only exacerbated in rural and underserved communities, where medical care is even less accessible.
One of the most common conditions dermatologists diagnose and treat is skin cancer. One in every five Americans develop skin cancer by the age of 70 and one American dies from melanoma almost every hour of every day. It is extremely important to diagnose melanoma at the earliest stages and even relatively short delays in diagnosis can have deadly consequences. While the initial assessment of the skin can be performed visually, definitive diagnosis often requires diagnostic tissue testing. Even though telemedicine can expand access to dermatologists and improve early detection of skin cancer, it is ideally married with in-home diagnostic testing to have the greatest impact on skin cancer care.
The Future of Teledermatology
It is clear that teledermatology can address the increasing demand and limited access to dermatological healthcare. In-home diagnostic testing enabled by remote skin sample collection will further help fill the gap in care, allowing patients to receive a more definitive diagnosis and the need for treatment or further testing. One form of at-home diagnostic testing for skin cancer is the use of the DermTech Melanoma Test, a genomic test enabled by the non-invasive Smart Sticker adhesive patch sample collection system.
In this paradigm, the patient can photograph a mole that may be suspicious of melanoma using the DermTech Connect smart phone application. Concerning moles typically have one of more ABCDE criterial indicative of melanoma risk. This photograph is securely sent to a dermatologist for review. If the reviewing dermatologist determines the mole does have a risk for melanoma, the DermTech Smart Sticker™ can be sent to the patient’s home and a sample from the lesion can be collected under the supervision of a licensed provider via telehealth. The skin sample is returned to the DermTech Gene Lab by standard FedEx shipping with no special handling requirements, where it is tested for genomic markers of melanoma. Positives tests are referred to a dermatologist for a confirmatory biopsy, while negative tests allow the mole to be monitored for change over time by the patient. Because approximately 85% of moles tested do not have genomic changes indicative of melanoma, the vast majority of patients can avoid a trip to the dermatologist. In addition, there is a >99% likelihood that a lesion is benign if the test is negative, giving patients peace of mind that the mole does not harbor melanoma. As this testing platform expands to non-melanoma skin cancer, the most prevalent cancer in the world, access to quality dermatology care and skin cancer care can be dramatically expanded.
We can expect innovation in telehealth to continue in the coming months and years, improving how medical professionals take care of people virtually and extract the right information to make an informed recommendation or diagnosis. As in-home diagnostic testing becomes more prevalent, telehealth visits will become more meaningful for both patients and providers. Remote sample collection and diagnostic testing will continue to be refined and advanced, taking on a new level of customization for patients that will allow for easier access to better care.