Dermatology is a highly utilized service in the UCSF system with long wait times and limited accessibility. Previous teledermatology work demonstrates that wait times for patients are reduced from 9 months to 2 days for an initial triage consult  and to 2 weeks for a live consult.

AIM 1: By tracking billing and collections in a  teledermatology system vs usual care system, the SETPOINT for payment of teledermatology services  will be determined. HYPOTHESIS: teledermatology will be cost neutral or less expensive than usual care while INCREASING ACCESS and DECREASING WAIT TIMES.

AIM 2: To bring sophisticated and efficient technologic tools developed for teledermatology to the UCSF  system allowing for integration of systems. The integrated system will be assessed for ease of use, speed and reliability.

AIM 3: To assess provider satisfaction at the beginning and end of the study period to assess for efficiency of consults and acceptance and level of satisfaction for providers.