Understanding Telemedicine and its use in Aesthetics

By Chloé Gronow / 28 Aug 2020

Practitioners explore the impact of COVID-19 and the use of telemedicine in the aesthetic specialty

The start of this year marked unprecedented times; an infection that started on a smaller scale, but quickly spread all over the world. Pandemics have occurred before, and although we face many struggles, we aesthetic practitioners can adapt and be prepared for a new approach to clinical practice.

Understanding the epidemiology of pandemics and our role as a medical health professional is an utmost necessity. Telemedicine is a blessing and with the advancements in technology and the current situation demanding it, is proving to be appealing, though it has its own caveats. It does seem to work not only as a standby modality but an important part of an aesthetic professional’s approach to the ‘new normal’ clinical practice in the near future, which we will explore in this article.

The aesthetic practice and business

A survey by Hamilton Fraser with 1,360 respondents was undertaken between March 22-24 regarding the impact of COVID-19 on UK clinics. Results found that 72% didn’t have a contingency plan, while of the 28% who did have a plan, one of the primary options was returning to the NHS.1,2 Yet ensuring continuity of care and increasing the likelihood of returning and new aesthetic customers, with effective and timely communication as clinics reopen, is pivotal. Aesthetic practitioners across the globe must try to make the best use of technological advancements in communication today and get innovative to maintain employment and business.

Aesthetic business relies a lot on loyalty and over time a bond of trust and a relationship is built with patients.3 In times of enforced closure, maintaining this relationship is vital, implying that we’re all in this together.4 Ensuring return business is not about doing one or two big things but ‘little things’.

Many practitioners have benefitted from using social media (SM), email or other telemethods to post positive messages and updates, a personal courtesy message or video, advice on home skincare that could be performed or regular SPF application for example, whilst spending more time outside gardening, walking or exercising.

SM platforms such as Facebook and Instagram are changing the nature of how we communicate, collaborate, and market our business.5 Targeted SM campaigns can be beneficial in promoting products as well as enabling clinics to provide an insight for potential customers into what is available.6

However, SM doesn’t capture all current and potential patients; clinics need to have a host of communication methods in order to maintain current relationships and cultivate newer ones. The go-to medium for functionality and patient satisfaction in these times is telemedicine.

Telemedicine and its use in pandemics

Telemedicine can be defined as the use of electronic communication and technology to provide healthcare to patients when distance or situations makes it impossible for an ‘in person’ meeting.7 This is delivered predominantly through existing user devices like mobile phones, tablets, computers and laptops. The main benefits of telemedicine are providing a way to address barriers that limit access to healthcare, while reducing the cost of care and saving time.8

Telemedicine serves as a means for practitioners to consult with patients, undertake an evaluation, diagnose and to provide a care plan remotely, which is especially pertinent during pandemics, with the benefit of reducing risk to both patients and practitioners.9,10 Especially in aesthetic practice, owing to its visual and non-emergency nature, this mode of clinical practice is very useful.11

Telemedicine allows professionals to share educational information with peers too. The use of telemedicine has been commonplace in various forms for 20 years and is standard medical practice in many parts of North America and Europe, with evidence supporting its cost effectiveness, clinical benefit, good patient satisfaction in concordance with in-person consultations.11 The World Health Organization (WHO) has also included telemedicine among essential services aimed at strengthening healthcare in times of pandemics, while supporting it as an alternative and/or supplement for clinical services.9

Teledermatology: various types, pros and cons

Different types of telemedicine exist to support remote communication:10,12

Live/real time options like use of telephone for consultations, radio to link up emergency medics to medical centres, video conferencing, certain websites, kiosks, mobile phone and wearable devices allows practitioners to see patients in real time during examination.

Non-real time include ‘store and forward’ methods which means that data may be stored in the device and sent across as per convenience.

Both real and non-real time through dedicated third-party platforms in the form of apps such as Mfine, DocsApp, JustDoc, Lybrate, MedHarbour, MonkMed and Practo. These allow patients to connect with doctors and provide both real and non-real time communication.

These platforms give the practitioner an organised and secure way to practise remotely, tracking the data of the patient and documenting all remote patient visits. Consent forms can be signed electronically with integrated billing where charges are transferred to the practitioner instantly. The practitioner is able to prescribe drugs using digital prescription services where options of even pre-set safe prescriptions may be transferred directly to pharmacies. Most of these platforms have medical device integration, allowing transfer of information using mobiles.13 Based on mode of communication, there are four types of telemedicine describable today (see Figure 1).12,14

Most studies and reviews have been optimistic about teledermatology practice.15 Results from a randomised controlled trial with a sample size of 392 participants showed that ‘store and forward methods’ did not result in longer wait times for patients when compared with face-to-face consultations.16 These methods offered comparable long-term clinical outcomes when compared with conventional clinic-based care.17 Another study included 17 teledermatologists across different settings that provided access to healthcare for underserved populations. Significant challenges were faced whilst trying to provide an efficient service; these included poor image quality, insufficient medical history taking, expensive software and miscommunication with providers, as well as lack of training on how to use technology.18

Concerns with telemedicine

An important concern in telemedicine is privacy and confidentiality of patient information, security of data and lack of implementation models.19,20 The legal and ethical approach is to protect confidentiality and keep the personal data of patients private. The European Union General Data Protection Regulation (GDPR) restricts the transfer of personal data to the countries outside the EU. Many parts of the world also follow GDPR guidelines. Taking informed consent is much harder during remote practice, but it is necessary. The Medical Defence Union (UK) advises consent for the remote consultation is ascertained, outlining limitations and potential security risks.21 Other challenges with telemedicine are ensuring safety from cyber-attacks, quick infrastructure scalability and internet bandwidth issues.9 There are several issues that can cause a difficulty with a virtual consultation, including:

  • Patients being late or missing the appointment
  • Poor internet connection
  • Disruptions from others
  • Poor lighting
  • Difficulty in picking up non-verbal communication

A recently published article by Aesthetics provides helpful guidance on how to overcome some of the difficulties with telemedicine as described here.22

Getting back into business: being responsible, adaptations and precautions

Getting back to work is something that makes practitioners across the globe more anxious than they were during the closure of clinics due to the pandemic. Many practitioners may question the future of their businesses and careful planning for re-opening and moving forward is crucial. Several aesthetic associations and organisations have published guidance on safely returning to practice, which can all be viewed via the Aesthetics website.23

Consulting and advising through online consultations need to be adopted to continue practice. This reduces the amount of unnecessary contact and encourages social distancing. Practitioners must remember their duty of care to patients even through such trying times.24

Experiencing and getting through a pandemic is both a scare and a learning opportunity. It takes a slow and steady path uphill to reach that ‘normal’ aesthetic practice that was in the pre-pandemic period. The ‘new normal’ needs patience and perseverance, it needs caution and adaptation. It is said that the stronger the storm one goes through, the brighter the rainbow at the end. In the case of aesthetics, patient needs and demands will rise, so will we as an industry with evolved, proficient and renewed energy.

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