Teledermatology in the Waikato region of New Zealand

Teledermatology consultations over a video-link began at Health Waikato in 1995. Clinical trials involving about 500 patients have demonstrated the di agnostic accuracy and economic gains of these teleconsultations, and patien t satisfaction with them. Yet, six years on, out-of-date equipment remains under-used. There has been no expansion of the network and no additional cl inical teleconsultation services. Possible reasons include the excessive ca pital cost of videoconferencing equipment, clinician overwork, inconvenienc e, lack of reimbursement, administrative and governmental inertia, and litt le demand from patients and their doctors. To widen our referral base witho ut the inconvenience of videoconferencing, we decided to offer a secure bro wser-based dermatology tele-advice service to referring general practitione rs who owned digital cameras. With the increase in online health informatio n and electronic communication, we assumed it would be popular. But, despit e up to six-month waits for patients to be seen in the dermatology outpatie nt clinic, few patients have been referred to the service. Explanations hav e included time constraints, unavailability of a camera, no Internet access at the time of consultation and lack of reimbursement. Can we look forward to a future in which all doctors have high-speed access to the Internet at their desktop through their practice management systems? Who will pay? Wil l they continue to prefer conventional referral?.