Fig. 1

Teledermatology virtual clinic process depiction. Figure 1 outlines the hybrid teledermatology virtual clinic process. The process begins with the patient (labeled figure on left) presenting to their primary care provider (PCP) with a rash or lesion at a Duke Primary Care site. The PCP then completed an e-consult encounter form with images and the Duke Telehealth office contacts the patient to schedule a video visit with the dermatology team within 3–5 days. Prior to the video visit, the dermatology team (an attending dermatologist with a resident or advanced practice provider) reviews the e-consult form with associated dermoscopy and clinical images. Before the visit, patient is reminded of the visit and an option to e-check in is sent through patient portal. On the day of the visit, the TD nurse virtually initiates the video call, rooms the patient in the virtual waiting room, reviews intake questionnaire, and notifies the dermatology team to initiate visit. The primary dermatology team then conducts the video visit with the patient and recommends treatment. Options for follow-up include PCP follow-up for low-risk visits, TD nurse follow up for moderate complexity visits or in-person follow-up for complex visits or for concerning lesions and rashes requiring biopsy. The telephone-conducted TD nurse follow-up can vary from 2 to 6 weeks, dictated by the TD attending and based on the expected treatment response rate. If treatment is unsuccessful, the TD nurse has the option to schedule a follow-up TD visit versus an in-person visit for the patient. The blue box indicates the in-person portion of teledermatology. APP: advanced practice provider; AVS: after visit summary; E-comm: e-consult; ED: emergency department; Derm MD: attending dermatology; PCP: primary care provider; RN: nurse; Signature care: Duke concierge medicine service; TD: teledermatology