Vol. 31. No. 3


“Technology is a useful servant but a dangerous master,”
said Christian Lous Lange, a recipient of the 1921
Nobel Peace Prize.1 This statement is as true today as it
was then. As physicians, we must leverage technology
to improve the quality and efficiency of patient care, not
to replace good medical decision making. We must
make technology our “servant”, not our “master”.
Information technology (IT) can “serve” physicians in
many ways. It can help us take advantage of the vast
body of literature available to make well-informed decisions
based on the latest “best practices.” It can help
us be more efficient. Efficiency may come from the ease
and rapidity of accessing patient data from an electronic
health record without the waste of storing vast amounts
of paper charts and expending a great deal of manpower
to organize and search among those charts. Efficiency
may also come from using tablets to quickly show patients
a library of before and after pictures relating to
their upcoming procedure. These, and many more examples,
are available in this issue of Seminars in Cutaneous
Medicine and Surgery.
The common thread of nearly all of the IT tools we
use in medicine is that they help us to record, manage,
organize, and/or recall information. These duties are
increasingly relegated to technology rather than to humans.
In fact, in this age of information overload, IT is
a necessity, as managing the vast amounts of patient
and medical data is nearly impossible.
Today, we see more patients daily than were seen by
doctors 50 years ago, and because of legal and billing
reasons, we need to document so much more with every
visit. At the same time, the medical literature is growing
at an unprecedented rate, making it nearly impossible
to keep up. In 2011 alone, there were over 25,000 new
articles indexed in PubMed related to the skin. Over
6600 of those related to skin cancer.2 One must read
18 articles a day, every day of the year, just to stay
abreast of the indexed skin cancer literature, and that
number keeps growing. This does not include the nonindexed
body of literature, such as textbooks and nonindexed
journal articles. These facts make a strong case
for tighter integration of technology, specifically IT, in
our specialty.
The medical field is adapting by training physicians
to use IT to handle the onslaught of information. Early
in their careers, medical students and residents are being
armed with computers, tablets, and mobile-phone–
based information resources. They are starting rotations
with electronic health record systems and learning to
access needed data in an electronic format. With this
foundation along with learning tools, such as teaching
videos for every procedure, virtual dermatopathology,
e-books, and countless “apps” for reference, they will
thrive in a world of information overload. It will be
almost as important to weed out and quickly find the
information that you need as it is to have a solid base of
medical knowledge.
Patients will also adapt to new ways information is
exchanged between the patient and physician, but there
will be challenges. Just as the transition from physicians
who made house calls to office-based practices required
a fundamental change in consumer philosophy, the
transition to teledermatology will not come easy. However,
it is already proving to be an efficient way to
perform preliminary diagnoses and triage true dermatologic
urgencies versus benign conditions. For several
years now, we have received pictures on our mobile
phones from emergency-room physicians, primarycare
doctors, as well as from dermatologic colleagues.
These electronic “curbside consults” help prioritize and
better use our valuable specialty care appointments.
This is just one iteration away from receiving the “consults”
directly from patients.
The last decade has brought tremendous technologic
innovations and advances to dermatology and dermatologic
surgery. Within this issue, you will find many of
these new tools and how they can change the way you
interact with patients, interact with other physicians,
and how you practice medicine. However, don’t forget
that IT is no more than a tool. It is not a substitute for
knowledge and good medical decision making. As the
health care provider, you have the primary responsibility
of weighing in factors of a patient’s current state,
mental or physical, to render a decision. The IT tools
today cannot be a substitute for human decision making.
Therein lies the art of medicine, which no technology
can take away from us; at least not yet.

Decision Support in Dermatology and Medicine: History and Recent Developments

Art Papier, MD

This article is focused on diagnostic decision support tools and will provide a brief history
of clinical decision support (CDS), examine the components of CDS and its associated
terminology, and discuss recent developments in the use and application of CDS systems,
particularly in the field of dermatology. For this article, we use CDS to mean an interactive
system allowing input of patient-specific information and providing customized medical
knowledge-based results via automated reasoning, for example, a set of rules and/or an
underlying logic, and associations.
Semin Cutan Med Surg 31:153-159 © 2012 Elsevier Inc. All rights reserved.


Special Requirements for Electronic Health Records in Dermatology

Mark D. Kaufmann, MD | Shraddha Desai, MD

Government incentives and mandates to increase the meaningful use of electronic health
records (EHR), with subsequent disincentives by Medicare, have made a significant push
for dermatologists to adopt this technology into their practices. EHRs were originally
developed for primary care physicians; however, owing to the unique features of dermatology,
specialty-specific systems are a must. In this article, we discuss the special needs
of dermatologists when choosing an EHR system.
Semin Cutan Med Surg 31:160-162 © 2012 Elsevier Inc. All rights reserved.


YouTube and the Expanding Role of Videos in Dermatologic Surgery Education

Ashish C. Bhatia, MD | Jeffrey T.S. Hsu, MD | Komal D. Koya, MS, MBA | Kyle R. Bhatia

Video is an excellent medium for medical education, both for clinicians and for the public.
YouTube has emerged as one of the largest sources of freely accessible content. It is our
intent to provide a preliminary discussion of the growing role of videos in medical education,
sources of this video content, and the format of surgical video content on YouTube.
Additionally, we will highlight the limitations and pitfalls that clinicians and the public
should be aware of when viewing online video content. Several sources of both patient- and
clinician-directed videos are easily accessible from the Internet and DVDs today. Medical
professionals, students, and patients now have mobiles and instantaneous access to a
growing collection of video content. A brief list of online video sources to view and learn
dermatologic surgical techniques is provided. Given the increasing ease of creating and
posting high-quality video content, this list will continue to grow, providing dermatologic
surgeons with an ever-increasing wealth of visual knowledge. Although YouTube is a
dominant source of publicly accessible videos, clinicians and consumers should be aware
of the source and intent of the video content before accepting the content. Although it is
easy to post content on YouTube, it is difficult to verify sources and the credentials of the
people posting the videos. Therefore, the viewer should filter content with a discerning eye,
embracing the concept of caveat emptor—or buyer beware.
Semin Cutan Med Surg 31:163-167 © 2012 Published by Elsevier Inc.


Social Media in Dermatology: Moving to Web 2.0

Robin L. Travers, MD

Patient use of social media platforms for accessing medical information has accelerated in
parallel with overall use of the Internet. Dermatologists must keep pace with our patients’
use of these media through either passive or active means are outlined in detail for 4
specific social media outlets. A 5-step plan for active engagement in social media applications
is presented. Implications for medical professionalism, Health Insurance Portability
and Accountability Act compliance, and crisis management are discussed.
Semin Cutan Med Surg 31:168-173 © 2012 Published by Elsevier Inc.


Mobile Applications for Dermatology

Michael Deveau, BS | Suneel Chilukuri | Suneel Chilukuri, MD

The number of available mobile applications has increased by 500% over the past 3 years.
Searching for useful dermatology applications may be overwhelming. The following summary
may help both advanced and budding dermatologists select useful programs.
Semin Cutan Med Surg 31:174-182 © 2012 Elsevier Inc. All rights reserved.