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Chuchu N, Dinnes J, Takwoingi Y, Matin RN, Bayliss SE, Davenport C, Moreau JF, Bassett O, Godfrey K, O'Sullivan C, Walter FM, Motley R, Deeks JJ, Williams HC. Teledermatology for diagnosing skin cancer in adults. Cochrane Database Syst Rev 2018; 12:CD013193. [PMID: 30521686 PMCID: PMC6517019 DOI: 10.1002/14651858.cd013193] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Teledermatology provides a way for generalist clinicians to access the opinion of a specialist dermatologist for skin lesions that they consider to be suspicious without referring the patients through the normal referral pathway. Teledermatology consultations can be 'store-and-forward' with electronic digital images of a lesion sent to a dermatologist for review at a later time, or can be live and interactive consultations using videoconferencing to connect the patient, referrer and dermatologist in real time. OBJECTIVES To determine the diagnostic accuracy of teledermatology for the detection of any skin cancer (melanoma, BCC or cutaneous squamous cell carcinoma (cSCC)) in adults, and to compare its accuracy with that of in-person diagnosis. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, US National Institutes of Health Ongoing Trials Register, NIHR Clinical Research Network Portfolio Database and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies evaluating skin cancer diagnosis for teledermatology alone, or in comparison with face-to-face diagnosis by a specialist clinician, compared with a reference standard of histological confirmation or clinical follow-up and expert opinion. We also included studies evaluating the referral accuracy of teledermatology compared with a reference standard of face-to-face diagnosis by a specialist clinician. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where there were information related to the target condition of any skin cancer missing. Data permitting, we estimated summary sensitivities and specificities using the bivariate hierarchical model. Due to the scarcity of data, we undertook no covariate investigations for this review. For illustrative purposes, we plotted estimates of sensitivity and specificity on coupled forest plots for diagnostic threshold and target condition under consideration. MAIN RESULTS The review included 22 studies reporting diagnostic accuracy data for 4057 lesions and 879 malignant cases (16 studies) and referral accuracy data for reported data for 1449 lesions and 270 'positive' cases as determined by the reference standard face-to-face decision (six studies). Methodological quality was variable with poor reporting hindering assessment. The overall risk of bias was high or unclear for participant selection, reference standard, and participant flow and timing in at least half of all studies; the majority were at low risk of bias for the index test. The applicability of study findings were of high or unclear concern for most studies in all domains assessed due to the recruitment of participants from secondary care settings or specialist clinics rather than from primary or community-based settings in which teledermatology is more likely to be used and due to the acquisition of lesion images by dermatologists or in specialist imaging units rather than by primary care clinicians.Seven studies provided data for the primary target condition of any skin cancer (1588 lesions and 638 malignancies). For the correct diagnosis of lesions as malignant using photographic images, summary sensitivity was 94.9% (95% confidence interval (CI) 90.1% to 97.4%) and summary specificity was 84.3% (95% CI 48.5% to 96.8%) (from four studies). Individual study estimates using dermoscopic images or a combination of photographic and dermoscopic images generally suggested similarly high sensitivities with highly variable specificities. Limited comparative data suggested similar diagnostic accuracy between teledermatology assessment and in-person diagnosis by a dermatologist; however, data were too scarce to draw firm conclusions. For the detection of invasive melanoma or atypical intraepidermal melanocytic variants both sensitivities and specificities were more variable. Sensitivities ranged from 59% (95% CI 42% to 74%) to 100% (95% CI 48% to 100%) and specificities from 30% (95% CI 22% to 40%) to 100% (95% CI 93% to 100%), with reported diagnostic thresholds including the correct diagnosis of melanoma, classification of lesions as 'atypical' or 'typical, and the decision to refer or to excise a lesion.Referral accuracy data comparing teledermatology against a face-to-face reference standard suggested good agreement for lesions considered to require some positive action by face-to-face assessment (sensitivities of over 90%). For lesions considered of less concern when assessed face-to-face (e.g. for lesions not recommended for excision or referral), agreement was more variable with teledermatology specificities ranging from 57% (95% CI 39% to 73%) to 100% (95% CI 86% to 100%), suggesting that remote assessment is more likely recommend excision, referral or follow-up compared to in-person decisions. AUTHORS' CONCLUSIONS Studies were generally small and heterogeneous and methodological quality was difficult to judge due to poor reporting. Bearing in mind concerns regarding the applicability of study participants and of lesion image acquisition in specialist settings, our results suggest that teledermatology can correctly identify the majority of malignant lesions. Using a more widely defined threshold to identify 'possibly' malignant cases or lesions that should be considered for excision is likely to appropriately triage those lesions requiring face-to-face assessment by a specialist. Despite the increasing use of teledermatology on an international level, the evidence base to support its ability to accurately diagnose lesions and to triage lesions from primary to secondary care is lacking and further prospective and pragmatic evaluation is needed.
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Affiliation(s)
- Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jacqueline F Moreau
- University of Pittsburgh Medical CenterInternal MedicineDepartment of Medicine, Office of EducationUPMC Montefiore Hospital, N715PittsburghUSAPA, 15213
| | - Oliver Bassett
- Addenbrooke's HospitalPlastic SurgeryHills RoadCambridgeUKCB2 0QQ
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | | | - Fiona M Walter
- University of CambridgePublic Health & Primary CareStrangeways Research Laboratory, Worts CausewayCambridgeUKCB1 8RN
| | - Richard Motley
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Augustin M, Wimmer J, Biedermann T, Blaga R, Dierks C, Djamei V, Elmer A, Elsner P, Enk A, Gass S, Henningsen M, Hofman-Wellenhof R, von Kiedrowski R, Kunz HD, Liebram C, Navarini A, Otten M, Reusch M, Schüller C, Zink A, Strömer K. Praxis der Teledermatologie. J Dtsch Dermatol Ges 2018; 16 Suppl 5:6-57. [DOI: 10.1111/ddg.13512] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Johannes Wimmer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Tilo Biedermann
- Hautklinik Campus Biederstein; Technische Universität München, München
| | - Rolf Blaga
- Psoriasis Selbsthilfe Arbeitsgemeinschaft e. V.; Berlin
| | | | | | - Arno Elmer
- Hochschule für Ökonomie und Management Berlin, Berlin
| | - Peter Elsner
- Klinik für Hautkrankheiten; Universitätsklinikum Jena, Jena
| | - Alexander Enk
- Hautklinik; Universitätsklinikum Heidelberg, Heidelberg
| | | | - Maike Henningsen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | | | | | | | - Marina Otten
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | - Alexander Zink
- Dermatologischen Universitätsklinik; Technischen Universität München, München
| | - Klaus Strömer
- Gemeinschaftspraxis für Dermatologie und Allergologie; Mönchengladbach
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McKoy K, Antoniotti NM, Armstrong A, Bashshur R, Bernard J, Bernstein D, Burdick A, Edison K, Goldyne M, Kovarik C, Krupinski EA, Kvedar J, Larkey J, Lee-Keltner I, Lipoff JB, Oh DH, Pak H, Seraly MP, Siegel D, Tejasvi T, Whited J. Practice Guidelines for Teledermatology. Telemed J E Health 2016; 22:981-990. [PMID: 27690203 DOI: 10.1089/tmj.2016.0137] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.
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Affiliation(s)
- Karen McKoy
- 1 Department of Dermatology, Lahey Hospital and Medical Center , Burlington, Massachusetts
- 2 Harvard Medical School , Boston, Massachusetts
| | | | - April Armstrong
- 4 Southern California Clinical and Translational Science Institute (SC CTSI) , Los Angeles, California
- 5 Department of Dermatology, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Rashid Bashshur
- 6 University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Anne Burdick
- 9 University of Miami Miller School of Medicine , Miami, Florida
| | - Karen Edison
- 10 Department of Dermatology, University of Missouri School of Medicine , Colombia , Missouri
- 11 Missouri Telehealth Network, University of Missouri School of Medicine , Colombia , Missouri
- 12 Center for Health Policy, University of Missouri School of Medicine , Colombia , Missouri
| | - Mark Goldyne
- 13 Department of Dermatology, University of California San Francisco , San Francisco, California
- 16 Dermatology Service, San Francisco VA Healthcare System , San Francisco, California
| | - Carrie Kovarik
- 14 Department of Dermatology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Elizabeth A Krupinski
- 15 Department of Radiology and Imaging Sciences, Emory University , Atlanta, Georgia
| | - Joseph Kvedar
- 17 Connected Health, Partners HealthCare , Boston, Massachusetts
| | - Jim Larkey
- 19 Canfield Scientific , Parsippany, New Jersey
| | - Ivy Lee-Keltner
- 21 Department of Dermatology, University of California Los Angeles-Olive View , Los Angeles, California
| | - Jules B Lipoff
- 14 Department of Dermatology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Dennis H Oh
- 13 Department of Dermatology, University of California San Francisco , San Francisco, California
- 16 Dermatology Service, San Francisco VA Healthcare System , San Francisco, California
| | - Hon Pak
- 18 Department of Dermatology, The George Washington University , Washington, DC
| | - Mark P Seraly
- 25 Department of Dermatology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Daniel Siegel
- 20 State University of New York Health Sciences Center at Brooklyn , Brooklyn, New York
| | - Trilokraj Tejasvi
- 22 Department of Dermatology, University of Michigan , Ann Arbor, Michigan
| | - John Whited
- 23 Research and Development, Durham VA Medical Center , Durham, North Carolina
- 24 Department of Medicine, Duke University School of Medicine , Durham, North Carolina
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Byrom L, Lucas L, Sheedy V, Madison K, McIver L, Castrisos G, Alfonzo C, Chiu F, Muir J. Tele-Derm National: A decade of teledermatology in rural and remote Australia. Aust J Rural Health 2015; 24:193-9. [DOI: 10.1111/ajr.12248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lisa Byrom
- Dermatology Department; Mater Misericordiae Health Service; Brisbane Queensland Australia
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Lex Lucas
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Vicki Sheedy
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Kim Madison
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Lachlan McIver
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - George Castrisos
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Christina Alfonzo
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Frank Chiu
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Jim Muir
- Dermatology Department; Mater Misericordiae Health Service; Brisbane Queensland Australia
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
- South East Dermatology; Brisbane Queensland Australia
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Abstract
This article provides an overview of teledermatology with an emphasis on the evidence most relevant to referring clinicians, who are often primary care clinicians. Discussion includes the different modalities used for teledermatology and their diagnostic reliability, diagnostic accuracy, impact on in-person dermatology visits, clinical outcomes, and user satisfaction.
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Affiliation(s)
- John D Whited
- Research and Development, Durham Veterans Affairs Medical Center, Research and Development (151), 508 Fulton Street, Durham, NC 27705, USA; Division of General Internal Medicine, Duke University School of Medicine, 411 West Chapel Hill Street, Suite 500, Durham, NC 27701, USA.
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Vañó-Galván S, Hidalgo Á, Aguayo-Leiva I, Gil-Mosquera M, Ríos-Buceta L, Plana M, Zamora J, Martorell-Calatayud A, Jaén P. Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:277-83. [DOI: 10.1016/j.ad.2010.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 11/03/2010] [Accepted: 11/03/2010] [Indexed: 11/27/2022] Open
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Warshaw EM, Hillman YJ, Greer NL, Hagel EM, MacDonald R, Rutks IR, Wilt TJ. Teledermatology for diagnosis and management of skin conditions: A systematic review. J Am Acad Dermatol 2011; 64:759-72. [PMID: 21036419 DOI: 10.1016/j.jaad.2010.08.026] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/04/2010] [Accepted: 08/21/2010] [Indexed: 01/08/2023]
Affiliation(s)
- Erin M Warshaw
- Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota 55417, USA.
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8
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Vañó-Galván S, Hidalgo Á, Aguayo-Leiva I, Gil-Mosquera M, Ríos-Buceta L, Plana M, Zamora J, Martorell-Calatayud A, Jaén P. Store-and-Forward Teledermatology: Assessment of Validity in a Series of 2000 Observations. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1578-2190(11)70803-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ludwick DA, Lortie C, Doucette J, Rao J, Samoil-Schelstraete C. Evaluation of a Telehealth Clinic as a Means to Facilitate Dermatologic Consultation: Pilot Project to Assess the Efficiency and Experience of Teledermatology Used in a Primary Care Network. J Cutan Med Surg 2010; 14:7-12. [DOI: 10.2310/7750.2010.09012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Primary care offices spend considerable time coordinating the specialist referral process. Patients experience long wait times for consultation and intervention. Objective: To determine if telehealth combined with interdisciplinary team–based care can reduce wait times for dermatologic consultation while making the consultation process easier for physicians. Methods: Retrospective chart reviews as well as patient, referring physician, nonreferring physician, clinic physician, nurse, and teledermatologist interviews were used to evaluate the clinic. A comparative immersion approach generated themes from field notes. Wait times, appointment times, and encounter durations were measured. Results: Twenty-eight patients were seen (23 had previous specialist referral experience) within 1 week of referral compared to a wait period of 104 days for conventional referral. Patients requiring intervention were treated within 1 week of their initial appointment. Referring practitioners were concerned that they would lose control of patients' care. An easier referral process and faster intakes met physician expectations. Conclusions: Teledermatology improves the timeliness of appointments. Patients forgo face-to-face appointments if alternatives are available sooner. Physicians are concerned about their own liability if dermatologists do not assess the patient in person but will refer through teledermatology when patients are seen faster and they remain in control of the care process.
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Affiliation(s)
- David A. Ludwick
- From the Department of Mechanical Engineering, University of Alberta, Edmonton, AB; Sherwood Park–Strathcona County Primary Care Network, Sherwood Park, AB; TR Labs, Edmonton, AB; and Division of Dermatology, University of Alberta, Edmonton, AB
| | - Charles Lortie
- From the Department of Mechanical Engineering, University of Alberta, Edmonton, AB; Sherwood Park–Strathcona County Primary Care Network, Sherwood Park, AB; TR Labs, Edmonton, AB; and Division of Dermatology, University of Alberta, Edmonton, AB
| | - John Doucette
- From the Department of Mechanical Engineering, University of Alberta, Edmonton, AB; Sherwood Park–Strathcona County Primary Care Network, Sherwood Park, AB; TR Labs, Edmonton, AB; and Division of Dermatology, University of Alberta, Edmonton, AB
| | - Jaggi Rao
- From the Department of Mechanical Engineering, University of Alberta, Edmonton, AB; Sherwood Park–Strathcona County Primary Care Network, Sherwood Park, AB; TR Labs, Edmonton, AB; and Division of Dermatology, University of Alberta, Edmonton, AB
| | - Christine Samoil-Schelstraete
- From the Department of Mechanical Engineering, University of Alberta, Edmonton, AB; Sherwood Park–Strathcona County Primary Care Network, Sherwood Park, AB; TR Labs, Edmonton, AB; and Division of Dermatology, University of Alberta, Edmonton, AB
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11
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S. Levin Y, Warshaw EM. Teledermatology: A Review of Reliability and Accuracy of Diagnosis and Management. Dermatol Clin 2009; 27:163-76, vii. [DOI: 10.1016/j.det.2008.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Romero G, Garrido J, García-Arpa M. Telemedicina y teledermatología (I): concepto y aplicaciones. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74735-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Krupinski E, Burdick A, Pak H, Bocachica J, Earles L, Edison K, Goldyne M, Hirota T, Kvedar J, McKoy K, Oh D, Siegel D, Antoniotti N, Camacho I, Carnahan L, Boynton P, Bakalar R, Evans R, Kinel A, Kuzmak P, Madden BC, Peters S, Rosenthal L, Simmons S, Bernard J, Linkous J. American Telemedicine Association’s Practice Guidelines for Teledermatology. Telemed J E Health 2008; 14:289-302. [DOI: 10.1089/tmj.2007.0129] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elizabeth Krupinski
- Arizona Telemedicine Program, Department of Radiology Research, University of Arizona, Tucson, Arizona
| | - Anne Burdick
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Hon Pak
- Advanced Information Technology Group Telemedicine and Advanced Technology Research Center, Ft. Detrick, Maryland
| | - John Bocachica
- Departments of Dermatology and Teledermatology Alaska Federal Health Care Access Network, Anchorage, Alaska
| | - Lucius Earles
- Section of Dermatology, Department of Medicine, Mt. Sinai Hospital, Chicago, Illinois
| | - Karen Edison
- Department of Dermatology, University of Missouri Health Care, Columbia, Missouri
| | - Marc Goldyne
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Tom Hirota
- Dermatology Services, Madigan Army Medical Center & Department of Dermatology, F. Edward Hebert School of Medicine, Uniformed Services, University of Health Sciences, Bethesda, Maryland
| | - Joseph Kvedar
- Center for Connected Health Partners HealthCare System, Inc., Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Karen McKoy
- Lahey Clinic, Department of Dermatology, Burlington, Massachussetts & Department of Dermatology, Harvard Medical School, Boston, Massachussetts
| | - Dennis Oh
- Department of Dermatology, University of California San Francisco & Dermatology Service, San Francisco VA Medical Center, San Francisco, California
| | - Dan Siegel
- Department of Dermatology, SUNY Downstate, Brooklyn, New York
| | | | - Ivan Camacho
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
| | - Lisa Carnahan
- Information Technology Laboratory National Institute of Standards and Technology, Gaithersburg, Maryland
| | - Paul Boynton
- Information Technology Laboratory National Institute of Standards and Technology, Gaithersburg, Maryland
| | | | | | - Al Kinel
- Alliances Kodak Corporation, Rochester, New York
| | - Peter Kuzmak
- Department of Veterans Affairs VistA Imaging Project, Silver Spring, Maryland
| | - Brian C. Madden
- VISN 2 Telemedicine Department of Veterans Affairs and Department of Dermatology, University of Rochester, Rochester, New York
| | | | - Lynne Rosenthal
- Information Technology Laboratory National Institute of Standards and Technology, Gaithersburg, Maryland
| | - Scott Simmons
- Miller School of Medicine, University of Miami, Miami, Florida
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Romero G, Garrido J, García-Arpa M. Telemedicine and Teledermatology (I): Concepts and Applications. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70307-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Romero G, Cortina P, Vera E. Telemedicine and Teledermatology (II): Current State of Research on Dermatology Teleconsultations. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Eminović N, de Keizer NF, Bindels PJE, Hasman A. Maturity of teledermatology evaluation research: a systematic literature review. Br J Dermatol 2007; 156:412-9. [PMID: 17300227 DOI: 10.1111/j.1365-2133.2006.07627.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a growing interest in teledermatology in today's clinical practice, but the maturity of the evaluation research of this technology is still unclear. OBJECTIVES This systematic review describes the maturity of teledermatology evaluation research over time and explores what kind of teledermatology outcome measures have been evaluated. METHODS Systematic review of literature found in Medline database (1966 up to April 2006). A telemedicine evaluation strategy consisting of four consecutive research phases (parallel to drug and diagnostics evaluation research) extended with a fifth postimplementation phase was used to classify all included studies by two independent reviewers. In addition, main characteristics (store-and-forward or real-time, study design, outcome measures) were registered. RESULTS Three hundred and forty-five papers were systematically selected from Medline, and 244 papers were excluded. For two randomized controlled trials (RCTs), multiple papers in phase III were found. After correcting for this, 99 studies remained included (11 phase I, 72 phase II, two phase III, six phase IV, eight postimplementation phase). The number of phase II studies is the largest and still growing, while other phases are much less represented. Diagnostic accuracy was the most often used outcome measure and was found in phase I, II and IV. Store-and-forward teledermatology has been evaluated more since 2001, but most phase IV studies (RCTs, including cost aspects) are on real-time teledermatology. CONCLUSIONS Most teledermatology evaluation studies are classified as feasibility studies (phase II). The number of phase III and IV studies remains low through the years. Compared with other specialties in telemedicine (i.e. telesurgery, telepaediatrics), teledermatology seems to be a mature application. However, more evaluation studies with a focus on clinical outcomes such as preventable referrals or time to recovery are needed to prove that teledermatology indeed is a promising and cost-saving technology.
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Affiliation(s)
- N Eminović
- Department of Medical Informatics, Academic Medical Centre, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
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Romero G, García M, Vera E, Martínez C, Cortina P, Sánchez P, Guerra A. [Preliminary results of DERMATEL: prospective randomized study comparing synchronous and asynchronous modalities of teledermatology]. ACTAS DERMO-SIFILIOGRAFICAS 2007; 97:630-6. [PMID: 17173824 DOI: 10.1016/s0001-7310(06)73483-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION There is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects. MATERIAL AND METHODS One-hundred-fifty.nine patients referred by the general practitioner in the first consult were randomized (algorithm 3:2:1) in three arms: asyncronous teledermatology (store-and-forward or SAF), synchronous teldermatology (real-time or VTC), and conventional consult (CC). We used high-quality, fixed digital images in all cases. The patients on the VTC teledermatology arm were also evaluated by videoconference. Finally all patients attended a face-to-face consult, considered the gold standard of patient care. A second dermatologist evaluated the diagnostic and management concordance between the teleconsults and the face-to-face consults. RESULTS One-hundred.forty-seven patients completed the study as follows: 74 in the SAF teledermatology arm, 47 in the VTC teledermatology arm and 26 in the conventional consult (control group). The teledermatological (SAF and VTC) and face-to-face evaluations were identical in 100 of 121 patients (82.6%). The errors were mild in 14 cases (11.6%) and severe in 7 (5.8%). The diagnostic concordance was very high (kappa=0,813). The errors grouped by diseases were as follows: 6/54 (11%) for tumors, 10/30 (33.3%) for inflammatory conditions, 1/20 (5%) for infectious diseases, 3/12 (25%) for alopecia/acne and 1/5 (20%) for others. There were 15 errors in the SAF teledermatology arm (20.3%) and 6 in the VTC teledermatology arm (12.8%); these differences were not statistically significant (chi2 1.12; p=0.288). CONCLUSION The reliability of dermatological teleconsult is very high, especially for tumoral or infectious diseases. The synchronous interaction with audio requires more resources, is difficult to coordinate and its diagnostic efficacy is not superior to SAF teledermatology.
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Affiliation(s)
- G Romero
- Unidad de Dermatología, Hospital General de Ciudad Real, Spain.
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19
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Abstract
Teledermatology consultations can be performed using either store-and-forward or real-time technology. The best-studied aspect of teledermatology is diagnostic reliability, also known as diagnostic agreement. A good level of diagnostic reliability is achieved by dermatologists using both store-and-forward and real-time modalities and is comparable to that found between clinic-based examiners. Less information is available regarding diagnostic accuracy. Current data suggest that teledermatologists reviewing store-and-forward consults achieve accuracy comparable to that of clinic-based dermatologists. When store-and-forward consult systems are used, approximately one in four in-person clinic appointments are averted. Real-time consult systems avoid the need to schedule approximately one in two clinic visits. Store-and-forward technology results in timelier interventions for patients when compared to a conventional referral process. To date, surveys of both store-and-forward and real-time teledermatology consult modalities suggest that patients, referring clinicians, and dermatologists are all highly satisfied with teledermatology consults. Very little has been published about the economic impact of store-and-forward teledermatology, whereas several studies have evaluated real-time modalities. Teledermatology has ranged from a cost-saving strategy to an intervention that incurs greater costs than conventional care, depending on the health care setting and economic perspective. Future research focusing on diagnostic accuracy, clinical outcomes using clinical course or disease status as outcome measures, development of reliable and valid teledermatology-specific survey instruments, and economic analyses that assess cost-effectiveness will help guide future teledermatology program assessments and policy.
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Affiliation(s)
- John D Whited
- Institute for Clinical and Epidemiologic Research, Department of Veterans Affairs Medical Center, Durham, NC 27705, USA.
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20
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Integrating Digital Image Management Software for Improved Patient Care and Optimal Practice Management. Dermatol Surg 2006. [DOI: 10.1097/00042728-200606000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Kadurina M, Mitoff K. Teledermatology. BIOTECHNOL BIOTEC EQ 2005. [DOI: 10.1080/13102818.2005.10817176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Patricoski C, Kokesh J, Ferguson AS, Koller K, Zwack G, Provost E, Holck P. A comparison of in-person examination and video otoscope imaging for tympanostomy tube follow-up. Telemed J E Health 2004; 9:331-44. [PMID: 14980090 DOI: 10.1089/153056203772744653] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objective of this study was to determine if video otoscope still images (640 x 480 pixel resolution) of the tympanic membrane following surgical placement of tympanostomy tubes are comparable to an in-person microscopic examination. Forty patients having undergone tympanostomy tube placement in both ears were independently examined in-person by two otolaryngologists and imaged using a video otoscope and telemedicine software package. The two physicians later reviewed images at 6 and 12 weeks. Physical examination findings and diagnosis were documented and compared for their concordance using kappa statistics. For both physicians, the intraprovider concordance between the in-person examination and the corresponding image review was high for each of the physical examination findings: Tube In 93-94% (K 0.85-0.87), Tube Patent 86-93% (K 0.74-0.85), Drainage 94-98% (K 0.42-0.66), Perforation 85-98% (K 0.40-0.84), Granulation 95-99% (K -0.01 to 0.00), Middle Ear Fluid 89-91% (K -0.03 to 0.50), and Retracted 89-94% (K 0.13-0.43). These agreement rates are similar to the normal interprovider concordance observed when two physicians independently examined the same patient in-person for physical exam findings: Tube In 96% (K 0.93), Tube Patent 94% (K 0.88), Drainage 96% (K 0.56), Perforation 90% (K 0.60), Granulation 96% (K 0.39), Middle Ear Fluid 88% (K 0.14), and Retracted 91% (K 0.43). For both physicians, the intraprovider diagnostic concordance between the in-person examination and the corresponding image review was high 79-85% (K 0.67-0.76). The interprovider diagnostic concordance for the in-person exam was 88% (K 0.81). The interprovider diagnostic concordance when two physicians independently reviewed all images was 84% (K 0.74), and 89% (K 0.80) when poor images were excluded. This study demonstrates that physician review of video otoscope images is comparable to an in-person microscopic examination. Store-and-forward video otoscopy may be an acceptable method of following patients post-tympanostomy tube placement.
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Affiliation(s)
- Chris Patricoski
- Alaska Federal Health Care Access Network, Anchorage, Alaska, USA.
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23
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Whited JD, Hall RP, Foy ME, Marbrey LE, Grambow SC, Dudley TK, Datta S, Simel DL, Oddone EZ. Teledermatology's impact on time to intervention among referrals to a dermatology consult service. Telemed J E Health 2003; 8:313-21. [PMID: 12419025 DOI: 10.1089/15305620260353207] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to determine if a teledermatology consult system, using store-and-forward digital imaging technology, results in patients achieving a shorter time from referral date to date of initial definitive intervention when compared to a traditional referral process. Patients being referred to the dermatology consult service from the primary care clinics at the Durham VA Medical Center were randomized to either a teledermatology consultation or usual care. A usual care consultation consisted of a text-based electronic consult request. A teledermatology consultation included digital images and a standardized history, in addition to the text-based electronic consult. Time to initial definitive intervention was defined as the time between referral date and the date the patient was scheduled for a clinic visit for those patients that the consultant requested a clinic-based evaluation, or the time between referral date and the date the consult was answered by the consultant if a clinic visit was not required. Patients in the teledermatology arm of the study reached a time to initial definitive intervention significantly sooner than did those patients randomized to usual care (median 41 days versus 127 days, p = 0.0001, log-rank test). Additionally, 18.5% of patients in the teledermatology arm avoided the need for a dermatology clinic-based visit compared to zero patients avoiding a dermatology clinic visit in the usual care arm of the study (p < 0.001, z-test). Teledermatology consult systems can result in significantly shorter times to initial definitive intervention for patients compared to traditional consult modalities, and, in some cases, the need for a clinic-based visit can be avoided.
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Affiliation(s)
- John D Whited
- Institute for Clinical and Epidemiologic Research, VA Medical Center, Durham, North Carolina, USA.
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24
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Abstract
Teledermatology is in essence an application of clinical telemedicine that deals with the practice of dermatology via the latest communication and information technology. As with other telemedicine applications, the goal is to provide the highest quality of dermatologic care more efficiently by moving patient information rather than the patient. Teledermatopathology, on the other hand, is a nonclinical telemedicine application specifically relating to diagnosis of cutaneous histologic specimens. There are numerous articles evaluating diagnostic concordance of teledermatology. However, because of a lack of a "true" gold standard, most published studies have compared diagnostic capabilities of teledermatology to our traditional face-to-face evaluations. Although the diagnostic correlation varies from study to study, most experts agree that Store and Forward and real-time video teleconferencing teledermatology is as clinically effective as a face-to-face consultation, which is less than 100% accurate. Teledermatopathology is showing similar potential, but because of the limitations on sampling error and the high cost of the alternative, robotic remote telepathology units, its acceptance into our daily practice has been delayed. This article focuses mainly on Store and Forward Teledermatology given its significant advantage and reviews the literature on teledermatology and teledermatopathology's diagnostic concordance and acceptance.
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Affiliation(s)
- Hon S Pak
- Department of Dermatology, Brooke Army Medical Center, San Antonio, USA
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25
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Abstract
Because of their remoteness, the majority of rural towns in Australia are disadvantaged in terms of access to dermatological services. Telemedicine offers one solution. Since the mid-1990s, Australian dermatologists have experimented with telemedicine as an adjunct to clinical practice. The technical viability of teledermatology was first demonstrated in 1997. In 1999, the accuracy and reliability of teledermatology were demonstrated in a real-life urban setting. In 2001, Broken Hill (in western New South Wales), a location remote from dermatology services, served as a trial site for the institution of teledermatology as the primary method of accessing dermatological services. High patient and general practitioner acceptability and positive medical outcomes were demonstrated, but the study also revealed unexpected barriers and pitfalls in the effective operation of rural teledermatology.
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Affiliation(s)
- A C Lim
- Department of Dermatology, St George Hospital, Kogarah, New South Wales, Australia
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26
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Chau PYK, Hu PJH. Information Technology Acceptance by Individual Professionals: A Model Comparison Approach. DECISION SCIENCES 2001. [DOI: 10.1111/j.1540-5915.2001.tb00978.x] [Citation(s) in RCA: 674] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lim AC, Egerton IB, See A, Shumack SP. Accuracy and reliability of store-and-forward teledermatology: preliminary results from the St George Teledermatology Project. Australas J Dermatol 2001; 42:247-51. [PMID: 11903155 DOI: 10.1046/j.1440-0960.2001.00529.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Teledermatology is the practice of dermatology across distances (and time) and involves the transfer of electronic information. To be effective and safe, the teledermatology process needs to demonstrate an acceptable level of accuracy and reliability. Accuracy is reflected by the degree of concordance (agreement) between the teledermatology and face-to-face diagnoses. Reliability is dependent on how consistently a set of results can be reproduced across different operators. Mean concordance (primary diagnoses) achieved by four dermatologists studying 53 store-and-forward diagnostic cases, originating from 49 referred patients, was 79% (range 73-85%). When the differential diagnoses were taken into account, the variation across individual dermatologists narrowed further, with a mean of 86% (range 83-89%). In contrast, the mean general practitioner (GP; n=11) concordance (GP face-to-face vs reference dermatologist store-and-forward diagnoses) was 49%. An interim review of all 49 teledermatology patients showed no adverse outcome at the end of 3 months. The ability to request face-to-face visits by dermatologists, combined with GPs maintaining primary care of the referred patient, serve as additional safeguards for patients using a telemedicine system. Our results indicate that teledermatology management of referred skin complaints is both accurate and reliable.
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Affiliation(s)
- A C Lim
- Department of Dermatology, Dermatology and Skin Cancer Centre, The St George Hospital, 22 Belgrave Street, Kogarah, New South Wales 2217, Australia
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Krupinski E, Gonzales M, Gonzales C, Weinstein RS. Evaluation of a digital camera for acquiring radiographic images for telemedicine applications. Telemed J E Health 2001; 6:297-302. [PMID: 11110633 DOI: 10.1089/153056200750040156] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many rural sites cannot afford a digitizer to digitize radiographic films and transmit them via a telemedicine network for review by a radiology specialist. This project tested the feasibility of using a consumer digital still camera to photograph radiographic images and transmit them via a telemedicine network to a consulting hub site. In this study, the feasibility of using a digital camera to photograph plain film radiographs of 40 bone trauma cases from a rural health center in Arizona was tested. The cases were transmitted to the Arizona Telemedicine Program hub site using a private asynchronous transfer mode network based on T1 carriers. Two orthopedic surgeons and two radiologists reviewed the cases on a color monitor and the original film images. The readers also rated image quality. There were no significant differences in diagnostic accuracy between conventional film and telemedicine reading. Diagnostic agreement between film and monitor viewing was quite high, as was agreement in confidence ratings. Image quality was generally rated as excellent to good in both viewing conditions. Cases that did not correlate well were judged to have poor image quality, or diagnoses were based on photographs that had part of the diagnostic region of interest cropped off. It was determined that a digital still camera can be used effectively in many cases to photograph radiographic images for transmission and viewing via a telemedicine network, as long as adequate views, zoomed in regions of interest, and good quality original films are used in the acquisition process.
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Affiliation(s)
- E Krupinski
- Arizona Telemedicine Program, University of Arizona, Tucson, Arizona, USA.
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29
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30
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Krupinski EA, LeSueur B, Ellsworth L, Levine N, Hansen R, Silvis N, Sarantopoulos P, Hite P, Wurzel J, Weinstein RS, Lopez AM. Diagnostic accuracy and image quality using a digital camera for teledermatology. TELEMEDICINE JOURNAL : THE OFFICIAL JOURNAL OF THE AMERICAN TELEMEDICINE ASSOCIATION 2000; 5:257-63. [PMID: 10908439 DOI: 10.1089/107830299312005] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The study was designed to evaluate the effectiveness of digital photography for dermatologic diagnoses and compare it with in-person diagnoses. MATERIALS AND METHODS Patients referred for specialty consultations (n = 308) were recruited from a university dermatology clinic. Patients were examined in-person by one of three board-certified dermatologists who provided clinical diagnoses. Digital photos were obtained on all patients and were evaluated as computer images by a panel of dermatologists. RESULTS There was 83% concordance between in-person versus digital photo diagnoses. Intradermatologist concordance averaged 84%, and interdermatologist concordance averaged 81%. Decision confidence was rated as "very definite" to "definite" 62% of the time. Concordance with biopsy results was achieved in 76% of the cases. Image sharpness and color quality were rated "good" to "excellent" 83% and 93% of the time, respectively. CONCLUSION Digital photography for store-and-forward teledermatology produces high-quality images and diagnostic concordance rates that compare favorably with in-person clinical diagnoses.
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Affiliation(s)
- E A Krupinski
- Telemedicine Program, University of Arizona, University of Arizona College of Medicine, Tucson, AZ, USA
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High WA, Houston MS, Calobrisi SD, Drage LA, McEvoy MT. Assessment of the accuracy of low-cost store-and-forward teledermatology consultation. J Am Acad Dermatol 2000; 42:776-83. [PMID: 10775853 DOI: 10.1067/mjd.2000.104519] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Telemedicine has the potential to revolutionize the delivery of dermatologic care to underserved areas. OBJECTIVE Our purpose was to compare diagnoses from two types of dermatology consultations: telemedicine using store-and-forward (SAF) technology, and traditional face-to-face (FTF) office visits. METHODS Skin conditions were imaged with a consumer-grade digital camera. A standardized template was used to collect historical data. Information was stored in a secured database for access by 2 or 3 board-certified dermatologists. Results from the FTF visit were used to assess the accuracy of the SAF diagnoses. RESULTS A total of 106 dermatologic conditions in 92 patients were included. Concordance between FTF and SAF diagnoses was high, ranging from 81% to 89% for all 3 dermatologists. Clinically relevant disagreement occurred in only 4% to 8% of cases. Remaining disagreements did not affect patient care. Diagnostic confidence and image quality affected agreement. When cases of high confidence were analyzed separately, agreement increased to 88% to 100%. This increase was substantiated by means of a chi-square test between the high confidence and low confidence groups, which demonstrated statistical significance (P <. 005) for all dermatologists. Similarly, when cases of above average image quality were considered, agreement increased to 84% to 98%. Again this difference was substantiated by means of a chi-square test between adequate and poor images, with statistical significance for two dermatologists (P <.001). Accuracy was comparable between disease types with the exception of benign neoplasms, which demonstrated agreement of 22% to 46%. CONCLUSION These data support the use of existing digital technology to construct an accurate SAF teledermatology system. The inexpensive camera and widely available computer equipment make this an extremely affordable system. Furthermore, participating dermatologists appear well aware of system limitations, as reflected in the increased agreement for high confidence cases. Additional investigation of the accuracy of teledermatology for benign neoplasms is warranted.
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Affiliation(s)
- W A High
- Mayo Medical School, Mayo Clinic & Foundation, Rochester, MN 55905, USA
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Abstract
There are still considerable inequalities in the provision of primary care in the UK in relation to need. Recruitment and retention of general practitioners (GPs) is a problem, although this is worse in inner-city than in rural areas. The main problem in rural areas of the UK is the accessibility of health services. GP consultation rates, hospital outpatient attendance rates and inpatient admissions all decline with distance both to the doctors' surgeries and to hospitals. There is evidence that health services can be successfully and effectively delivered to isolated communities by telemedicine, but almost all of it relates to work done outside the UK. The experience has been generally good and should certainly be taken into account when planning future physician requirements and distribution.
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Affiliation(s)
- R Wootton
- Institute of Telemedicine and Telecare, Queen's University, Belfast, UK.
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Whited JD, Hall RP, Simel DL, Foy ME, Stechuchak KM, Drugge RJ, Grichnik JM, Myers SA, Horner RD. Reliability and accuracy of dermatologists' clinic-based and digital image consultations. J Am Acad Dermatol 1999; 41:693-702. [PMID: 10534630 DOI: 10.1016/s0190-9622(99)70003-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Telemedicine technology holds great promise for dermatologic health care delivery. However, the clinical outcomes of digital image consultations (teledermatology) must be compared with traditional clinic-based consultations. OBJECTIVE Our purpose was to assess and compare the reliability and accuracy of dermatologists' diagnoses and management recommendations for clinic-based and digital image consultations. METHODS One hundred sixty-eight lesions found among 129 patients were independently examined by 2 clinic-based dermatologists and 3 different digital image dermatologist consultants. The reliability and accuracy of the examiners' diagnoses and the reliability of their management recommendations were compared. RESULTS Proportion agreement among clinic-based examiners for their single most likely diagnosis was 0. 54 (95% confidence interval [CI], 0.46-0.61) and was 0.92 (95% CI, 0. 88-0.96) when ratings included differential diagnoses. Digital image consultants provided diagnoses that were comparably reliable to the clinic-based examiners. Agreement on management recommendations was variable. Digital image and clinic-based consultants displayed similar diagnostic accuracy. CONCLUSION Digital image consultations result in reliable and accurate diagnostic outcomes when compared with traditional clinic-based consultations.
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Affiliation(s)
- J D Whited
- Institute for Clinical and Epidemiologic Research, Veterans Affairs (VA) Medical Center, Durham, North Carolina 27705, USA
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Abstract
Digital photography is a powerful tool that is transforming the specialty of dermatology by integrating patient and practice management. The fundamentals of digital imaging are discussed, and an approach to the selection of a digital camera and its associated hardware and software is provided. The applications of this technology to patient and practice management are addressed, and the ethical implications of digital tampering are also discussed.
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Affiliation(s)
- D Ratner
- College of Physicians and Surgeons of Columbia University, New York, New York, USA
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Houston MS, Myers JD, Levens SP, McEvoy MT, Smith SA, Khandheria BK, Shen WK, Torchia ME, Berry DJ. Clinical consultations using store-and-forward telemedicine technology. Mayo Clin Proc 1999; 74:764-9. [PMID: 10473351 DOI: 10.4065/74.8.764] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the potential role of a store-and-forward (SAF) telemedicine system in specialty consultations initiated by primary care physicians. MATERIALS AND METHODS In this pilot telemedicine study, patients needing consultations in cardiology, dermatology, endocrinology, and orthopedics had both standard face-to-face (FTF) consultations and SAF consultations. RESULTS Fifteen patients had both FTF and SAF consultations, 4 had echocardiograms transmitted for an SAF consultation only, and 1 had an SAF consultation but no FTF appointment. Of 19 diagnoses made, all were essentially the same in both types of consultations; 14 of 15 FTF consultations and 15 of 19 SAF consultations resulted in additional treatment recommendations. CONCLUSIONS While it was possible to develop a desktop system for SAF consultations, the equipment was not adequately integrated. Without total digital input, including electronic patient medical records, packaging of information is laborious and impractical. Seamlessly adapting to existing clinical practice is vital. Issues such as increasing work for the physicians or office staff, gathering adequate patient information, and designing a referral process were more difficult than we had anticipated. Patient acceptance was high, but the clinical pilot had very small numbers.
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Affiliation(s)
- M S Houston
- Department of Family Medicine, Mayo Clinic Rochester, Minn. 55905, USA
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Harrison PV, Kirby B, Dickinson Y, Schofield R. Teledermatology--high technology or not? J Telemed Telecare 1998; 4 Suppl 1:31-2. [PMID: 9640726 DOI: 10.1258/1357633981931344] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
As an alternative to attending a conventional dermatology clinic, patients had a high-resolution conventional photographic image taken by a professional medical photographer. The photographic images were viewed by a dermatologist together with referral details from the general practitioner and any other relevant information from the patient's notes. From the images, a dermatological diagnosis was derived and a management plan for each patient instituted. After treatment, histological assessment of the tumours allowed diagnostic accuracy to be determined. The preliminary diagnostic accuracy (71%) was greater than that of the referring general practitioners (49%). However, when the diagnostic ability of the method to detect the nature of malignant lesions was examined, telemedicine was able to detect malignancies in 94% of cases compared with only 70% detected by general practitioners. The results of the present study indicate that teledermatology is achievable using a low-technology, low-cost approach.
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Affiliation(s)
- P V Harrison
- Dermatology Department, Queen Victoria Hospital, Morecambe, Lancashire, UK
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