Washington, Pa. company's online service puts dermatologists on call, cuts down on waiting times

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Have a weird rash? Blotchy cheeks? A troubling mole? Snap a few photos, upload the files to a website, answer a few questions online and you could have a prescription to treat it in three days -- rather than the weeks or even months it can take to schedule a dermatology appointment.

The service from a new Washington County company will cost you $69, and the online platform is now live, with seven Western Pennsylvania dermatologists at the ready and, possibly, many more to come.

Iagnosis, based in McMurray, was founded this year by Peters dermatologist Mark Seraly and Pittsburgh investor Lawrence E. Eakin Jr. The company has raised at least $1 million this year, according to a filing with the U.S. Securities and Exchange Commission. Iagnosis operates the "Dermatologist on Call" service.

While the product is new, having virtually "seen" about 150 patients since the end of September, Dr. Seraly has been seeing customers in this manner for years, using his own office computers, developing his own software and Web platform along the way.

The impetus, he said, was to cut down on wait times.

"We really saw, several years ago, that there was a growing inability for patients to get timely care by dermatologists. They have to wait months," he said.

One study, published in 2009 by Merritt Hawkins & Associates, said the average wait to see a skin doctor was 22 days, but within that average, there were wild variations depending on the region and clinic. Another study, reported in Journal of the American Academy of Dermatology, said the wait time was 38 days.

"We figured," Dr. Seraly said, "there had to be a better way."

That better way was via telemedicine, the next frontier in the health care industry. Teledermatology is practiced across the country, mostly at larger health care systems. The Department of Veterans Affairs, for example, has been trying to provide better access for its most isolated patients for years using telemedicine and tele-consultation technology, including dermatology services.

Go back a dozen years, and researchers were already saying that "teledermatology holds great potential for revolutionizing the delivery of dermatology services."

If dermatologists' use of telemedicine isn't new, the direct-to-consumer approach is.

While a few other companies are now operating in the same space -- California-based Direct Dermatology, for one, is using a similar model -- Dr. Seraly says his system has a head start by way of the 5,000 or so patients he's already seen this way, via his own practice, before the "Dermatologist on Call" model launched.

The practice needed "new access points for patients," he said. Typically, that patient is a woman, probably a mother in her 40s, using the technology to get a diagnosis for herself, her children or an aging parent.

"Look at what she avoids," said Bruce Kaplan, who is handling marketing for Iagnosis. "Missing work, taking children out of school. ... [Women] tend to be the keystone and driver for online care."

In the world of telemedicine, there are two primary types of consultation: real-time "face-to-face" chats, or video consultations; and the "store-and-forward" consultation, which is the method Iagnosis will use.

"Store-and-forward" works like it sounds -- the case file is sent in by the patients when it's convenient for them and then reviewed when it's convenient for the dermatologist.

Most of what Dr. Seraly reviews online is similar to what he sees in his office -- acne, eczema, poison ivy, skin cancer, fungal infections and a few more common maladies.

Easy cases will get prescriptions, if necessary, within 72 hours, while patients with suspected cancer or more troubling skin issues can be "prioritized" by the dermatologist and brought into the office more quickly.

Mr. Eakin, the company's chief operating officer, said the Dermatologist on Call service could be available outside of Pennsylvania by 2014, so long as enough dermatologists are recruited into the network. The long-range goal is 1,000 on board within five years. Another round of fund-raising is underway, he said.

Dermatologists will have to pay $60 a month to access the system, plus a monthly volume fee based on how many patients the doctor sees using the Iagnosis product.

What's in it for the doctors? More patients and less down time. A dermatologist can see four to six patients an hour, face to face, in his or her office. But he can review between 12 and 20 cases an hour online, Dr. Seraly said. And if a doctor has a few patients cancel appointments at the end of the day, that time -- and revenue -- isn't lost.

Right now, the product and access to the "closed network" of dermatologists is being marketed directly to consumers. Mr. Eakin and Dr. Seraly said institutional access is the next step, selling the service to nursing homes, emergency rooms, even prison systems.

Dermatologists have been slow to adopt direct-to-patient teledermatology, said Luke Lee, teledermatology manager at UC Davis Health System. The issue isn't technological, but rather regulatory reasons involving federal privacy rules.

"HIPPA requires patient records and images be sent securely," Mr. Lee said. But, he added, "The technology is there," and he expects other clinics will be players in the retail field in the next few years.

Another issue, he noted, is that insurers are slow to reimburse for new technology, meaning there's often a lag time between technological deployment and patient use.

Pittsburgh's largest insurer, Highmark Inc., announced Friday that it is partnering with Iagnosis to track utilization and consumer response.

Right now, the online dermatology review is not a covered benefit, said Paul Puopolo, Highmark's vice president of business innovation, but if the value of the service is proven over time, it could be added to future generations of insurance policies.

Highmark did not invest in the company, Mr. Puopolo said. It could in the future.

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Bill Toland: btoland@post-gazette.com or 412-263-2625.


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