The on-line dermatology doctor is in.

In a region defined by navigating around, across and above the waters of Puget Sound, Naval Hospital Bremerton has instituted a teledermatology service to support beneficiaries who live outside the 60-minute specialty care drive time from the hospital.

Teledermatology is a subset of Telehealth, a proven method of delivering safe and effective care where such geographic barriers and provider shortages exist, and allows Lt. Cmdr. Josephine Nguyen, NHB Dermatology department head, to bring dermatology care directly to patients in need.

"Teledermatology is effective for a broad range of dermatology conditions, including acne, eczema, psoriasis, skin infections and general skincare counseling. Because we are encouraging primary care manager (PCM) involvement, it allows us to empower these physicians to independently perform their own dermatologic treatments. I can teach the PCM to inject scars, areas of spot baldness and how to effectively administer liquid nitrogen to treat resistant warts," said Nguyen, also the sole Navy dermatologist to the Pacific Northwest

There is a high demand for a clinical specialty service such as dermatology, which provides diagnosis and treatment services for diseases of the skin. Delivering the services via teledermatology is proving to help increase access to care, prevent delays in care, facilitate provider-to-provider consultation, avoid unnecessary travel for patients as well as providers, improve patient and provider satisfaction, and potentially reduce the rate of "no-show" patient appointments.

Nguyen attests that teledermatology also adheres to Navy Medicine's priorities of readiness, value and jointness.

"There's value with the continuity of care we're providing. We're improving readiness by making it easy for patients to get in and be seen, and we're enhancing jointness by being able to care for Sailors from squadrons at Naval Air Station Whidbey Island and Sailors from Naval Station Everett. They do not have to travel here to be seen. We want everyone to know that even for something like a no-shave chit, they can go to the clinic and get an appointment for teledermatology," Nguyen said, adding that those using the service have been pleasantly surprised with the quality of care and see it as efficient and effective.

The proof of the effectiveness of teledermatology is that compiled statistical evidence show that 65 percent of patients who went elsewhere for the care they needed have returned to NHB due to the new service.

Planning for the service was finalized towards the end of 2014 and began between NHB and Branch Health Clinic Everett on Jan. 5, the first full week of 2015. Connectivity with Naval Hospital Oak Harbor came online in March.

The teledermatology service is limited from just NHB to the other military treatment facilities such as Branch Clinic Everett and Naval Hospital Oak Harbor, in accordance with the federal Health Insurance Portability and Accountability Act (HIPAA) and personal privacy regulations.

Teledermatology is based on patient safety considerations, patient and provider comfort levels, the ability of a clinic to identify a physical space conducive to a proper telehealth visit, and equipment suitable for clinical services provided and reliable connectivity. NHB's Information Management Department orchestrated the connectivity needs under the strict guidelines.

The premise for using the service is straightforward. A PCM and their patient will contact and then connect with Nguyen, who then can discuss, diagnose and go over treatment plans via teledermatology.

"Having both the PCM and patient at the appointment encourages continuity of care, and increases the education and ownership by the physician of the patient and for the patient," Nguyen said.

According to Nguyen, there is approximately one teledermatology appointment per day and a valuable selling point to those initially unused or uncertain about the technology is that the consult is in real time. The service is a new concept for a lot of people, especially those who like person-to-person interaction.

"Patients are also happy with being seen and getting 'in' quickly. Most of the patients are referrals so they are new to me, but we also have done follow-up appointments. A standard visit can average from five to 20 minutes," said Nguyen. "It's gratifying to be part of the education of the patient and the PCM. Once the PCM is on board and involved, that knowledge can be used in helping to diagnose others. It all helps to make us more efficient as we focus on our teamwork in helping other members of our Navy. Taking care of our patients and working together is a key to what we do."

NHB is part of the Puget Sound Military Health System, along with Madigan Army Medical Center and Naval Hospital Oak Harbor, and telehealth is a key initiative for providing direct care to beneficiaries. NHB has also started a tele-mental health service.

Madigan Army Medical Center, which already has a successful Tele-Behavioral Health program in place, is also planning to add teledermatology services, as well as expand to other areas as pain management and neurology.

Compiled information from Puget Sound Military Health System notes that NHB's teledermatology service is directly supporting the reach and effectiveness of the Military Health System in caring for beneficiaries and reducing costs.

"We're really pioneers with this process. NHB will focus on offering timely outpatient services, to support our valued military members, their families and retirees. NHB is maximizing our resources to maintain mission readiness, provide value and quality patient-centered health care to all patients," said Capt. Christopher Quarles, Naval Hospital Bremerton commanding officer.

The Joint Commission defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.

NHB has approximately 31,000 TRICARE enrollees in the West Puget Sound area of the greater Kitsap Peninsula, and another 5,150 in the Eastern Puget Area serviced by NHB's Branch Health Clinic Everett. Naval Hospital Oak Harbor has over 19,870 total enrolled.

Adding teledermatology as a recent patient-centered care electronic option follows the trend of the implementation at NHB of RelayHealth and the Nurse Advice Line.

NHB has been strongly encouraging all patients to enroll in RelayHealth, a secure messaging system. RelayHealth allows two-way communication between patients and their primary care manager and Medical Home Port Team to answer questions, refill medications, receive test results and more.

Patients can request appointments, renew prescriptions, ask non-urgent questions, and receive lab results, all from their home computer. This can reduce phone calls, waiting-room time, and the time it takes to travel to their doctor's office. Patients can use www.relayhealth.com/patients to consult with their doctors about non-urgent medical care needs.

The Nurse Advice Line (NAL) also available at NHB is staffed by a team of registered nurses who answer healthcare questions and provide live advice 24/7. NHB beneficiaries have the option to contact the NAL for professional medical advice to help decide whether self-care is the best option, or wait for an appointment with their primary care manager, or seek urgent or emergency care. Call 1-800-TRICARE (874-2273) and select option 1 to connect to the NAL. Beneficiaries may still call their Medical Home Port Team for medical advice and appointments during business hours.

"The NAL is just another example of self-service options available to help beneficiaries manage their healthcare needs around the clock," said Quarles.

NHB's Dermatology Clinic is open to active-duty members, retired personnel, and their families. All services are by appointment only. There is no walk-in service. Referrals from primary care providers are required for an appointment at the clinic.

Whether it's in person or now on-line, the doctor is in.

For more news from Naval Hospital Bremerton, visit www.navy.mil/.