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Castillo F, Peracca S, Oh DH, Twigg AR. The Utilization and Impact of Live Interactive and Store-and-Forward Teledermatology in a Veterans Affairs Medical Center During the COVID-19 Pandemic. Telemed J E Health 2021; 28:1186-1192. [PMID: 34919470 DOI: 10.1089/tmj.2021.0275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Teledermatology has emerged as a promising method of continuing dermatologic care during the coronavirus 2019 (COVID-19) pandemic, including in the Department of Veterans Affairs (VA). Analysis of the utilization and impact of teledermatology within the San Francisco Veterans Affairs Health Care System (SFVAHCS) may elucidate the ways that teledermatology programs can continue to be optimized. Methods: We conducted a retrospective analysis of live interactive encounters, Veterans Affairs Video Connect (VVC), store-and-forward telehealth (SFT), and face-to-face (FTF) consultations, performed within the SFVAHCS from March 2020 to December 2020. To assess utilization, we analyzed numbers of encounters throughout 2020. To assess impact, we analyzed primary diagnoses for each encounter and rates of recommendations for medications and lesion biopsies. Additionally, we assessed diagnostic accuracy associated with each teledermatology type by measuring concordance between teledermatologists' clinical diagnoses and histopathological diagnoses. Results: Two thousand two hundred fifty FTF, 347 VVC, and 470 SFT encounters were conducted from March to December 2020. More female patients utilized VVC, and patients who utilized VVC were younger than SFT and FTF users (p < 0.01). SFT was utilized more by patients from rural areas (p < 0.01). Diagnoses addressed were significantly different between VVC and SFT. A majority of VVC encounters involved referrals for inflammatory conditions; primary diagnoses associated with SFT consultations were most frequently neoplasms. Comparison of VVC and SFT outcomes showed that more VVC visits resulted in a medication recommendation, while more SFT consultations resulted in a biopsy recommendation. Conclusions: Teledermatology contributed to meeting patient needs throughout 2020 and created an impact on clinical management. Patient characteristics, diagnoses, and type of impact associated with encounters varied between SFT and VVC. This analysis provides insight into teledermatology utilization within the VA system and can contribute to efforts to improve the quality of teledermatology care for veterans.
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Affiliation(s)
- Francine Castillo
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sara Peracca
- Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
| | - Dennis H Oh
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
| | - Amanda R Twigg
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
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2
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Coustasse A, Sarkar R, Abodunde B, Metzger BJ, Slater CM. Use of Teledermatology to Improve Dermatological Access in Rural Areas. Telemed J E Health 2019; 25:1022-1032. [PMID: 30741608 DOI: 10.1089/tmj.2018.0130] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Raghav Sarkar
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Bukola Abodunde
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Brandon J. Metzger
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Chelsea M. Slater
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
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3
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Gemelas J, Capulong D, Lau C, Mata-Diaz S, Raugi GJ. Positive Predictive Value of Melanoma Diagnosis in Store-and-Forward Teledermatology. Telemed J E Health 2019; 25:701-707. [DOI: 10.1089/tmj.2018.0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordan Gemelas
- School of Public Health, University of Washington, Seattle, Washington
- School of Public Health, Oregon Health and Science University/Portland State University, Portland, Oregon
| | - Dana Capulong
- Department of Microbiology, University of Washington, Seattle, Washington
| | - Clayton Lau
- School of Public Health, University of Washington, Seattle, Washington
| | - Sandra Mata-Diaz
- School of Public Health, University of Washington, Seattle, Washington
| | - Gregory J. Raugi
- VA Puget Sound Health Care System, Seattle, Washington
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
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4
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Marwaha SS, Fevrier H, Alexeeff S, Crowley E, Haiman M, Pham N, Tuerk MJ, Wukda D, Hartmann M, Herrinton LJ. Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer. J Am Acad Dermatol 2019; 81:1099-1106. [PMID: 30738843 DOI: 10.1016/j.jaad.2019.01.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/11/2019] [Accepted: 01/19/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood. OBJECTIVE We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows. METHODS Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017. RESULTS One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective. LIMITATIONS Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias. CONCLUSION Implementation is critical to the effectiveness of teledermatology.
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Affiliation(s)
| | - Helene Fevrier
- Division of Research, Kaiser Permanente, Oakland, California
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente, Oakland, California
| | | | | | - Ngoc Pham
- Dermatology, Kaiser Permanente, Santa Clara, California
| | | | - Danny Wukda
- The Permanente Medical Group, Quality and Operations Support, Kaiser Permanente, Oakland, California
| | - Michael Hartmann
- The Permanente Medical Group, Quality and Operations Support, Kaiser Permanente, Oakland, California
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Yim KM, Florek AG, Oh DH, McKoy K, Armstrong AW. Teledermatology in the United States: An Update in a Dynamic Era. Telemed J E Health 2018; 24:691-697. [PMID: 29356616 DOI: 10.1089/tmj.2017.0253] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Teledermatology is rapidly advancing in the United States. The last comprehensive survey of U.S. teledermatology programs was conducted in 2011. INTRODUCTION This article provides an update regarding the state of teledermatology programs in the United States. MATERIALS AND METHODS Active programs were identified and surveyed from November 2014 to January 2017. Findings regarding practice settings, consult volumes, payment methods, and delivery modalities were compared to those from the 2011 survey. Findings from the Veterans Affairs (VA) were reported as an aggregate. RESULTS There were 40 active nongovernmental programs, amounting to a 48% increase and 30% discontinuation rate over five years. Academia remained the most common practice setting (50%). Median annual consultation volume was comparable with 263 consultations, but maximum annual consultation volume increased (range: 20-20,000). The most frequent payment method was self-pay (53%). Store-and-forward continued to be the most common delivery modality. In Fiscal Year 2016, the VA System consisted of 62 consultation sites and performed a total of 101,507 consultations. DISCUSSION The limitations of this study were that consult volume and payment methods were not available from all programs. CONCLUSION U.S. teledermatology programs have increased in number and annual consultation volume. Academia is the most prevalent practice setting, and self-pay is the dominant accepted payment method. Innovative platforms and the provision of direct-to-patient care are changing the practice of teledermatology.
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Affiliation(s)
- Kaitlyn M Yim
- 1 Department of Dermatology, University of Southern California , Los Angeles, California
| | - Aleksandra G Florek
- 1 Department of Dermatology, University of Southern California , Los Angeles, California
| | - Dennis H Oh
- 2 Department of Dermatology, University of Colorado , Aurora, Colorado
| | - Karen McKoy
- 3 Department of Dermatology, University of California San Francisco , San Francisco, California
| | - April W Armstrong
- 4 Lahey Clinic Department of Dermatology, Harvard Medical School , Burlington, Massachusetts
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Vedire K, Joselow AL, Markham CM, Raugi GJ. Teledermatology-directed surgical care is safe and reduces travel. J Telemed Telecare 2016; 22:121-6. [PMID: 26116856 DOI: 10.1177/1357633x15589861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
METHODS We conducted a retrospective chart review and identified 186 Veterans in the VA Corporate Data Warehouse as having malignant melanomas or severely dysplastic nevi during the four-year period of observation from 1 July 2009 to 30 June 2013 and met inclusion and exclusion criteria for analysis. RESULTS Three hundred and sixty-six surgical procedures were performed for diagnosis and treatment of these conditions including biopsy and wide-local excision, of which 189 carefully selected cases were performed by primary care clinicians with 2.0% biopsy complication rate and a 7.7% wide-local excision complication rate. Cases not performed by primary care providers were referred to specialists (e.g. dermatologists, general surgeons or specialty surgeons) who had a 2.5% complication rate in biopsies and wide-local excision complication rate of 13.5% in severely dysplastic nevi and pTis and pT1a lesions and a 10.7% complication rate for lesions pT1b and greater. DISCUSSION These results show that a significant fraction of surgical procedures for diagnosis and treatment of malignant melanoma and severely dysplastic nevi can be safely performed in rural clinics by trained primary care providers.
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Affiliation(s)
- Kirtana Vedire
- VA Puget Sound Health Care System, Seattle Division, USA
| | - Andrew L Joselow
- VA Puget Sound Health Care System, Seattle Division, USA Tulane University School of Medicine, New Orleans, USA
| | | | - Gregory J Raugi
- VA Puget Sound Health Care System, Seattle Division, USA University of Washington, Department of Medicine (Dermatology), Seattle, USA
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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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Bashshur RL, Shannon GW, Tejasvi T, Kvedar JC, Gates M. The Empirical Foundations of Teledermatology: A Review of the Research Evidence. Telemed J E Health 2015; 21:953-79. [PMID: 26394022 PMCID: PMC4776540 DOI: 10.1089/tmj.2015.0146] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This article presents the scientific evidence for the merit of telemedicine interventions in the diagnosis and management of skin disorders (teledermatology) in the published literature. The impetus for this work derives from the high prevalence of skin disorders, the high cost, the limited availability of dermatologists in certain areas, and the promise of teledermatology to address unmet needs in this area. MATERIALS AND METHODS The findings are based on a targeted review of scientific studies published from January 2005 through April 2015. The initial search yielded some 5,020 articles in Google Scholar and 428 in PubMed. A review of the abstracts yielded 71 publications that met the inclusion criteria for this analysis. Evidence is organized according to the following: feasibility and acceptance; intermediate outcomes (use of service, compliance, and diagnostic and treatment concordance and accuracy); outcomes (health improvement and problem resolution); and cost savings. A special section is devoted to studies conducted at the Veterans Health Administration. RESULTS Definitions of teledermatology varied across a wide spectrum of skin disorders, technologies, diagnostic tools, provider types, settings, and patient populations. Outcome measures included diagnostic concordance, treatment plans, and health. CONCLUSIONS Despite these complexities, sufficient evidence was observed consistently supporting the effectiveness of teledermatology in improving accessibility to specialty care, diagnostic and treatment concordance, and skin care provided by primary care physicians, while also reducing cost. One study reported suboptimal clinical results from teledermatology for patients with pigmented skin lesions. On the other hand, confocal microscopy and advanced dermoscopy improved diagnostic accuracy, especially when rendered by experienced teledermatologists.
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Affiliation(s)
- Rashid L. Bashshur
- eHealth Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Joseph C. Kvedar
- Center for Connected Health, Partners HealthCare, Boston, Massachusetts
| | - Michael Gates
- eHealth Center, University of Michigan Health System, Ann Arbor, Michigan
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Karavan M, Compton N, Knezevich S, Raugi G, Kodama S, Taylor L, Reiber GE. Teledermatology in the diagnosis of melanoma. J Telemed Telecare 2013; 20:18-23. [DOI: 10.1177/1357633x13517354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary We conducted a retrospective chart review of US Veterans in the Pacific Northwest area to compute melanoma incidence and Breslow depth at diagnosis. We compared Veterans with access to teledermatology (TD) and those without (non-TD). We identified pathology-confirmed primary melanomas in Veterans who had had at least one encounter at a VA facility during a 3-year study period. The age-adjusted melanoma incidence for all, TD and non-TD Veterans was 36, 15 and 57 per 100,000, respectively. The mean Breslow depth was significantly greater in the TD group ( P = 0.03). Although a higher proportion of thin (Breslow depth ≤1 mm) TD melanomas were mitotically active, this difference was not significant. We also found that 180 (40%) of the non-TD (face-to-face) diagnosed melanomas were from Veterans living in areas where TD was available. This suggests that the higher melanoma incidence in the non-TD group was mainly due to under-utilization of TD services. The study demonstrated that the TD service was not fully utilized in the VISN20 region, although the reasons for this are not clear. Where TD was utilized it tended to diagnose more advanced melanomas with worse initial prognosis.
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Affiliation(s)
- Mahsa Karavan
- Health Services Research and Development, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, USA
- School of Medicine, University of Washington, Seattle, USA
| | - Nicholas Compton
- Specialty Care Services, Division of Dermatology, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, USA
- School of Medicine, University of Washington, Seattle, USA
| | - Stevan Knezevich
- Division of Pathology, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, USA
- Department of Pathology, University of Washington, Seattle, USA
| | - Gregory Raugi
- Specialty Care Services, Division of Dermatology, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, USA
- School of Medicine, University of Washington, Seattle, USA
| | - Samantha Kodama
- Health Services Research and Development, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, USA
| | - Leslie Taylor
- Health Services Research and Development, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, USA
| | - Gayle E Reiber
- Health Services Research and Development, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, USA
- Department of Health Services, University of Washington, Seattle, USA
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10
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McFarland LV, Raugi GJ, Reiber GE. Primary Care Provider and Imaging Technician Satisfaction with a Teledermatology Project in Rural Veterans Health Administration Clinics. Telemed J E Health 2013; 19:815-25. [DOI: 10.1089/tmj.2012.0327] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lynne V. McFarland
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
- Department of Medicinal Chemistry, School of Public Health, University of Washington, Seattle, Washington
| | - Gregory J. Raugi
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
- Hospital and Specialty Medical Services, Teledermatology Section, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
| | - Gayle E. Reiber
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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