Commentary addresses shortcomings in direct-to-consumer pediatric teledermatology

In a commentary about the use of DTC teledermatology in the pediatric arena, the Dermatology Foundation outlined a framework of features needed for such services “to appropriately treat pediatric patients.”

The commentary, by Kavita Sarin, MD, of the department of dermatology, Joyce Teng, MD, of the departments of pediatrics and dermatology, and Alexander L. Fogel, MBA, a medical student at Stanford (Calif.) University, was written on behalf of the Dermatology Foundation in response to the lack of uniform standards and policies governing the use of DTC teledermatology services for pediatric patients.

The writers reported the results of their assessment of the pediatric policies of DTC teledermatology websites and smartphone-based services, which included whether a patient’s age and identity were verified, whether the validity of parental consent was confirmed, and whether any coordination with a patient’s primary care physician or with other physicians occurred.

None of the sites performed all of the features they considered necessary for online pediatric care. “Most services have very minor checks on pediatric access, such as a limit on self-reported age, or a click-box to indicate that parental consent for the visit has been given, and few services allow for medical record capture or coordination with other physicians,” they wrote (J Am Acad Dermatol. 2016 Sep 7. doi: 10.1016/j.jaad.2016.08.002).

Describing the situation as “problematic,” they proposed the framework with features needed for DTC pediatric teledermatology services, which could be “implemented through legislation, regulation, or a third-party certification process,” the researchers wrote.

“We recommend an approach that allows for ample data cross-referencing between patient and parent, and with publicly available records,” to verify identification and parental consent, they noted.

Other elements include the use of standard templates for inputting patient’s medical histories, and sending care plans to the physicians indicated by the parents and patients.

DTC teledermatology “has the potential to offer patients substantial benefits,” but “we must insist on high-quality DTC TD[teledermatology]-services that are coordinated, transparent, focused on quality rather than prescription-writing, and consistent with standards of in-person care,” they wrote.

None of the authors declared any conflicts of interest. Dr. Sarin is supported by a Dermatology Foundation Medical Dermatology Career Development Award.