• Jim Muir and Lex Lucas.
• Australian College of Rural and Remote Medicine.
• Stud Health Technol Inform. 2008 Jan 1; 131: 245-53.

AbstractAustralia is a large country with a small and scattered population. Specialist dermatology services are concentrated in the capital cities and larger urban centers on the coast. This has meant access to these services for Australians in rural and remote areas has been limited to those able to travel the often long distances to their nearest dermatologist. Due to a considerable shortage of dermatologists, waiting times to see one are more than six months. The challenge was to provide a dermatology service that overcame these twin obstacles of distance and demand. Telecommunication infrastructure in Australia is good and most towns have at least one general practitioner. More than 75% of all general practices are equipped with computers and have broadband internet access.Dermatology is a specialty with few life threatening disorders. However short delays in diagnosis and management of a skin condition rarely have any serious impact on a patient's long-term health. At the same time many skin problems are distressing, and difficult to diagnose and treat. Many skin conditions last for considerable periods of time and patients need ongoing care. Due to the highly visual nature of the specialty, most skin conditions can be diagnosed from an image especially if there is some history available. This often requires a trained specialist. Paradoxically, any needed investigations such as skin biopsy or blood tests can be performed by any qualified doctor. Dermatological treatments can be instituted and monitored by these same practitioners without any specialist training. These factors make tele-medicine an ideal solution to the problems of isolation from and excess demand for specialist dermatological services. In 2004 the Australian College of Rural and Remote Medicine (ACRRM) in a joint initiative with Queensland Divisions of General Practice (QDGP) set up Tele-Derm with funding from the Commonwealth Department of Health and Ageing under the Medical Specialist Outreach Assistance Program (MSOAP).Tele-Derm was set up as an online consultation service combined with a central portal for online dermatology education, resources, links, discussions and professional development activities. It was set up with the belief that a teledermatolgy service must offer ongoing education as well as a specific case consultation service. If the remote doctor does not have the skills to perform required procedures such as biopsy and excision then the patient will still need to travel. The common misconception about tele-dermatology is that this form of consultation is not as good as a face-to-face one with a dermatologist. But, in the majority of cases it is [1]. In any event Tele-Derm is not trying to provide a service that is necessarily better then the traditional mode of delivery. It wishes to provide a service where none currently exists. To this end, Tele-Derm provides teleconsultation and online education in dermatology to doctors Australia wide.

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