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Anne E. Burdick, MD, MPH
Professor of Dermatology
Associate Dean for TeleHealth
March 20, 2014
University of Miami TeleHealth
Enhancing Healthcare for Floridians UM TeleHealth is a catalyst for
healthcare transformation in Florida.
Access ConvenienceConvenience

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QualityQuality Cost
Synchronous
Real-time interactive
Asynchronous
Store-and-forward
We use all 3 operational TH modes
Synchronous
Real-time interactive
Asynchronous
Store-and-forward
We use all 3 operational TH modes
Hybrid

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University of Miami TeleHealth
• 1974: Dr Jay Sanders, prison telemedicine
• 1994: Fellowship at MCG, ATA Board member
•1994: Teledermatology for migrant workers, JAMA
•1996: American Academy of Dermatology Telemedicine
Position Statement
• 1999: Founded ATA Teledermatology Special Interest
Group Approved 2007
2007
Approved 2007
Endorsed by American Academy of Dermatology
2007
“Based on the history
and images provided,
my impression is as
follows.”
2008
UM TeleHealth: Our strengths
• Telehealth operations
• Technology & systems engineering
• Telehealth policy
• Industry relationships

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Our challenge: Limited TH reimbursement
• Medicaid: Children’s Medical Services via waiver
• Medicare: Rural, Health Provider Shortage Areas
• No private payers
Our challenge: Limited TH reimbursement
• Medicaid: Children’s Medical Services via waiver
• Medicare: Rural, Health Provider Shortage Areas
• No private payers
Our strategy:
• Contracts
• Grants
• Advocate for policy change
Dept of Health Children's Medical Services
• Teledermatology
• Telegenetics
• Telenutrition
• Telepsychiatry
Miami-Dade School Telehealth Initiative
• MD provides Pediatric care to
8 schools
• RN, MA or medical or nursing
students present
• Specialty care with UM MDs

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Miami-Dade School Telehealth Initiative
• North Miami Beach schools: elementary, middle and high
• Equipment: HRSA grant
• Health care providers: John T MacDonald grant,
Children’s Health Fund, AHEC
• Specialist reimbursement: Verizon Foundation grant
• Dermatology, Nutrition, Psychiatry, Cardiology,
Endocrinology
Miami-Dade School Telehealth Expansion
• Centers for Medicare and Medicaid Services grant
• 8th school
• Partnering with Larkin Hospital for telemental health
• Partnering with NOVA University for teledentistry
Eczema herpeticum
Generalized herpes simplex
infection + atopic dermatitis

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Eczema herpeticum
Generalized herpes simplex
infection + atopic dermatitis
Admitted for IV Acyclovir and
antibiotics for 3 days
Other Pediatric TH specialities
UM Pediatric Mobile Van
• Sweetwater, Little Haiti, Homestead
• Verizon Foundation grant for specialist
reimbursement, 4G network provided
• Nutrition, dermatology, cardiology
Telegenetics
•Statewide Newborn Screening conferences
Telehealth training of health providers
• Dermatology residents
• Medical students
• ARNP students
• DNP students
Core Competencies for residents
American College of Graduate Medical Education
• Interpersonal & Communication Skills
• Systems-Based Practice
• Patient Care
• Practice-Based Learning & Improvement

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Acute teleneurology to hospital
emergency departments
• Specialists on Call, Inc.
Discharge planning enhancement
• Patients transfers
• UM Hospital to Miami Jewish Home for the Elderly
• Verizon Foundation grant for a Vgo robot
UM-Aetna Employee TeleHealth
• UM employees
• At a satellite UM clinic,
• 10 miles or 45-60 minute drive or
Metrorail ride
• Specialty teleconsultations
• Neurology, dermatology, nutrition,
cardiology, pulmonary
Teletrauma: Ryder Jackson Memorial/University
of Miami Trauma Center
• Trauma bay resuscitations
• ICU bedside rounds
• Air ambulance optimization from
Lower Keys Medical Center
• Brazil Olympic team, London
• US Dept of State contract: 24/7

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Store-and-forward teledermatology
Nashville Area
Oklahoma Area
Albuquerque Area
2010: 75 Indian nations in 29 states
MICMAC
Pleasant Point, ME
Oneida, NY
Catawba, SC
4 yo: 3 days itching, sores hands & stomach
4 yo: 3 days itching, sores hands & stomach
………Scabies

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UM – Alaska Teledermatology Service
AFHCAN MISSION
To improve access to health care for
federal beneficiaries in Alaska through
sustainable telehealth systems
Alaska
Federal
Health
Care
Access
Network
Alaska’s Health Care Challenges
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• 49% MDs in Alaska are primary care
physicians, U.S. average is 28%
• 59% residents live in medically
underserved areas
• 48th in “doctors to residents” ratio
- 65% are located in Anchorage
- Shortages in many specialties
Average Alaska village = 350 Residents
Alaska Native Medical Center
• Tertiary care
• Referrals to private medical providers & other
states for complex care
• 6 regional hospitals
• 4 multi-physician health centers
• 25 subregional mid-level care centers
• 180 small community primary care centers
36

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Human assistance and disaster
response: TeleHealth in Haiti
• Trauma and critical care
• Teleradiology
• Pediatric subspecialties
Telemedicine for Trauma, Disaster, and
Emergency Management Eds: Latifi R, Poropatich R.
Artech House, Boston. 2010
“Economic Evaluation of Telemedicine: Review of
the Literature and Research Guidelines for
Benefit–Cost Analysis”
Dávalos ME, French MT, Burdick AE, Simmons SC
Telemedicine and e-Health. 2009, 15: 933-948
2009 Manuscript Award at ATA 2010 Plenary
, Cutis 88, 213: 2011

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UM Cruise Ship Teledermatology
• Provides rapid access to University of Miami dermatologists
for crew and occasionally guests on ships all over the world
• Within 72 hours or 24 hours
• Royal Caribbean Cruise Lines since June 2010
• Carnival Cruise Lines since November 2012
Teledermatology at Sea
• Provides dermatology care for an employee population
that’s geographically dispersed
• Allows ship’s medical staff to effectively manage their
crew’s skin conditions
• Reduces onshore dermatology visits
• Assists in medical evacuation decisions
• Cost avoidance
• UM selected Medweb software
• Cruise IT teams evaluated software
• Username/password assigned to each ship
• Introduced service at RCL/CCL conferences
• Lab and X-Ray capabilities determined
• Additional drugs recommended
• MDs and RNs reviewed UM’s online training
• Test case submitted by each ship before sending consults
Fleetwide Rollout Dermatology at Sea: Special Issues
• Limited drug formulary
• Challenging to access shoreside dermatologists
• Diverse occupations
• Off work or “dry” work difficult, no duplicate crew
• Maximum Medical Improvement
• Medical isolation
• Medical evacuation

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Ship MD UM Dermatology
ConsultantPhotos
Consult Form
PC
PC
Internet
UM
Server
S
Workflow Dermatology at Sea: Special Issues
• Limited drug formulary
• Challenging to access shoreside dermatologists
• Diverse occupations
• Off work or “dry” work difficult, no duplicate crew
• Maximum Medical Improvement
• Medical isolation
• Medical evacuation
Stat case: hand dermatitis, violinist
Tinea versicolor
Alopecia areataContact dermatitis
Wart

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Candida intertrigoErysepelis
Bullous cellulitisLeishmaniasis
“3 day painful rash with vesicles, left trunk. On
Acyclovir 800mg every 4 hours. Correct?”
“3 day painful rash with vesicles, left trunk. On
Acyclovir 800mg every 4 hours. Correct?”
Agree with Herpes zoster
and treatment
Rare Diseases
Multiple acral reticular histiocytosis
Hidradenitis
suppurativa
Relapsing
polychondritis

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Oral lesions: Torus palatinus
New England Journal of
Medicine, April 11, 2013
<5% consult: referred to dermatologist
Present x 1 month
Wart vs. squamous cell cancer vs
keratoacanthoma
Solitary nail pigmentation
Probable melanoma
Growing dark dot x 1 year
Probable melanoma
Stat case: Fever + coryza + rash, R/o Measles
Stat case: Erythema multiforme major

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UM TeleHealth is a catalyst for
healthcare transformation in
Florida and beyond.
Anne E. Burdick, MD, MPH
Associate Dean for TeleHealth
Professor of Dermatology
aburdick@med.miami.edu
(305) 243-8252
telehealth.med.miami.edu
Contact