Tele-Dermatology Through Telehealth and Healthcare Internet Technologies

Introduction

Healthcare in the U.S. is one of the most advanced globally but is also one of the most heavily affected systems by disparities. In 2018, the U.S. spent 16.9% of its GDP on healthcare, yet it has the lowest life expectancy among 11 high-income countries (Tikkanen & Abrams, 2020). The average U.S. citizen spent $1122 on out-of-pocket healthcare costs, covering insurance deductibles, visit co-pays, and prescriptions. Residents of France paid less than half for the same services (Tikkanen & Abrams, 2020). Furthermore, as the world continues to deal with epidemics and adjust to new ways, some initiatives established to lessen the healthcare cost burden on underserved communities are also vanishing.

However, one of the side effects of COVID-19 was the emergence of telemedicine as an alternative and, in some cases, a better solution to the regular practice of medicine. Telemedicine is establishing itself, among other things, to increase access to healthcare among the underserved. Telemedicine is a concept that has been introduced previously. The start can be traced back to 1879 when doctors started using phones to provide consultations (Rheuban & Krupinski, 2018). Over time, with technological advances, video and complete medical data were transmitted at the University of Nebraska in 1959 (Rheuban & Krupinski, 2018).

First, medical practices commonly require close and intensive interactions between healthcare professionals and patients (Henderson, 2006). The physical presence of clinicians is often critical throughout the different stages of health services, including diagnoses, treatment decisions, treatment administration, and patient follow-up (Tachakra & Rajani, 2002). The construction of these activities is what Foucault calls a medical gaze, which allows the doctor to abstract knowledge of illness objectively through observations, conversations with the patient, and physical examination (Foucault, 1975). Therefore, all visual, haptic, sonic, and kinaesthetic senses are necessary for the clinical examination, highlighting the importance of social presence in the medical context. Presence is needed because of the uncertainty associated with the critical variations between medical cases, including those in the same medical category (Wennberg, 1984).

Consequently, telemedicine clinical workflows can significantly differ from regular medical practices. This continuum of care shift requires the reconfiguration of workflows, depending on the type and particularities of the chosen system, which can significantly impact clinical outcomes and may cause disruptions to work practices (Yeow & Goh, 2015). Paul and McDaniel (2004) identified the need to reuse knowledge to facilitate collaboration among healthcare providers. Technology designed for telemedicine thus needs to accommodate the need for the actors' presence or account for the knowledge transfer required for collaborative clinical activities across organizations. For instance, some studies have drawn from socio-cognitive theories to design telemedicine systems that mimic face-to-face communication and make users feel close to healthcare providers (e.g., Zahedi et al. 2016). Second, the complexity and ambiguity of clinical diagnoses and treatment increase healthcare delivery challenges in person and virtually.