[Preliminary results of DERMATEL: prospective randomized study comparing synchronous and asynchronous modalities of teledermatology]

Assessing the Diagnostic Accuracy of Teledermatology Consultations at a Local Veterans Affairs Dermatology Clinic

With the advances in health information technology and the need for increased access to specialized health care, the advent of telemedicine was designed to bring care to individuals at a distance. Telemedicine decreases barriers to health care and brings medical specialists to underserved areas and populations. We have seen a tremendous increase in the need and utilization of telemedicine during the COVID-19 pandemic due to the lockdowns and social distancing efforts. Virtual care continues to be extended to patients to maintain their health care needs when in-person clinic appointments are not feasible or ideal such as seen during a pandemic. Telemedicine is an additional tool that has proven vital to our healthcare system. To provide optimal care, a strong technological infrastructure must be in place. Once in practice, positive outcomes have been noted for patients and healthcare providers as diagnosis, treatment, and appropriate triage can be made virtually and at the patients' convenience. To ensure high-quality care is provided through the Veterans Affairs teledermatology consultation service, we investigated the concordance of teledermatology diagnoses with clinical examination findings through a retrospective chart review covering a one-year time period. Our study found a concordance of 75.3% between the teledermatology diagnoses and the in-person clinical diagnoses. The main limitation we found to virtual examination is the inability to perform total body skin examinations. We found that 60.2% of patients had additional diagnoses when examined in person, with 8.4% of patients having an additional malignant diagnosis. These findings highlight the need for in-person examinations when feasible to ensure that no other diagnoses go undiscovered if not captured on the submitted images for teledermatology consultation. Despite the limitations posed by photographic examination, teledermatology can be used as a reliable method for diagnosis when a conventional in-person examination is not readily available or ideal, such as during a pandemic, and can serve as a powerful triaging tool.

Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review

Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation. The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically. The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings. The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.

[Diagnostic reliability of an asynchronous teledermatology consultation]

OBJECTIVE

To analyze the diagnostic agreement rate between primary care, an asynchronous teledermatology consultation, and a conventional dermatology consultation.

DESIGN

Prospective non-randomized concordance study.

SETTING

Dermatology Service in Hospital Son Llàtzer (Palma de Mallorca) and primary care centers of Sóller and Arenal (Mallorca).

PARTICIPANTS

Patients have been included from December 2005 to July 2008, sent by teleconsultation (n=158).

MAIN MEASUREMENTS

Analysis of primary care, teledermatology consultation and face-to-face consultation diagnosis, in mentioned period of time. Calculation of kappa index of concordance.

RESULTS

158 teleconsultations have been made from December 2005 to July 2008, 94 (59,5%) women, and 64 (40,5%) men, aged from 9 to 96 years old (average, 55 years old). After grouping the diagnosis in categories, the distribution was: 48 (37,2%) benign tumours, 39 (30,2%) inflammatory and appendages diseases, 15 (11,6%) infectious diseases, 14 (10,9%) malignant tumours, and 13 (10,1%) premalignant tumours. In grouped diagnosis, concordance was 59,8% (CI 95%, 50-70%) (P<.0001) for general practitioner and 94,7% (CI 95%, 90-99%) (P<.0001) for teledermatologist.

CONCLUSIONS

The main advantage of asynchronous teledermatology is the improvement of the quality triage, allowing the detection of malignant or suspicious lesions. However, we need more comparable studies on a larger scale to evaluate the disadvantages (photographic technique limitation, evaluation of other lesions, legal aspects, professional motivation...).

A mobile-phone based teledermatology system to support self-management of patients suffering from psoriasis

Psoriasis is one of the most common chronic skin diseases, affecting about 2% of the population world wide. Continuous clinical monitoring with periodic assessment of the state of the disease is essential for long-term therapy optimization. We present a mobile phone based telemedical compliance management system for psoriasis-patients. Using special software, patients can acquire health parameters such as their body weight, take photos of their psoriasis lesions, and report adverse effects. The data are automatically sent to a monitoring centre, where they are provided to the patient's physician via the use of a web-browser. In case of therapy relevant events, email or SMS notifications can be sent to the physician. If necessary, the physician can send feedback messages to the patient, e.g. for admitting the patient to the clinic for further examinations. The system has been implemented and functional tests have proven its functionality. Currently, the system is used in the course of a medical case series.