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Abstract
BACKGROUND/OBJECTIVES Store-and-forward teledermatology provides pediatricians with specialist guidance in managing skin disease. This study evaluates wait times and face-to-face (FTF) dermatology visit avoidance associated with a pediatric dermatology eConsult program at an urban academic medical center. METHODS In this retrospective cohort study, electronic medical records were reviewed for patients under age 18 for whom a dermatology eConsult was completed between November 1, 2014, and December 31, 2017. Wait times for eConsult completion and initial FTF dermatology appointments were calculated and compared to average wait times for new patient dermatology office appointments from 2016 to 2017. Recommendations for FTF dermatology visits were assessed, along with FTF visit attendance and potential cost savings. RESULTS One hundred eighty pediatric patients with 188 unrelated skin conditions ("cases") were referred to the program. Of 188 cases, FTF dermatology visits were recommended for 60 (31.9%). Actual FTF dermatology visit avoidance was 53.7% of total cases (n = 101 for whom FTF visit was not recommended and no dermatology visit occurred within 90 days after eConsult submission). The program generated potential savings of $24 059 ($9840 out-of-pocket) in 2016 dollars. Average turnaround for eConsult completion was 1.8 calendar days (median: 1 calendar day, target: 2 business days). Average wait time to initial FTF dermatology evaluation was 37.3 calendar days (versus 54.1 days for pediatric patients referred directly to dermatology clinic between 2016 and 2017). CONCLUSION Pediatric dermatology eConsults reduce wait times for specialist care, triage cases for in-office evaluation, reduce need for FTF dermatology visits, and offer potential cost savings for payers and patients.
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Affiliation(s)
| | - Elena B Hawryluk
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph C Kvedar
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Shinjita Das
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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Brinker TJ, Hekler A, von Kalle C, Schadendorf D, Esser S, Berking C, Zacher MT, Sondermann W, Grabe N, Steeb T, Utikal JS, French LE, Enk AH. Teledermatology: Comparison of Store-and-Forward Versus Live Interactive Video Conferencing. J Med Internet Res 2018; 20:e11871. [PMID: 30355564 PMCID: PMC6231765 DOI: 10.2196/11871] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 01/30/2023] Open
Abstract
A decreasing number of dermatologists and an increasing number of patients in Western countries have led to a relative lack of clinicians providing expert dermatologic care. This, in turn, has prolonged wait times for patients to be examined, putting them at risk. Store-and-forward teledermatology improves patient access to dermatologists through asynchronous consultations, reducing wait times to obtain a consultation. However, live video conferencing as a synchronous service is also frequently used by practitioners because it allows immediate interaction between patient and physician. This raises the question of which of the two approaches is superior in terms of quality of care and convenience. There are pros and cons for each in terms of technical requirements and features. This viewpoint compares the two techniques based on a literature review and a clinical perspective to help dermatologists assess the value of teledermatology and determine which techniques would be valuable in their practice.
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Affiliation(s)
- Titus Josef Brinker
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany.,Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
| | - Achim Hekler
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Christof von Kalle
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Esser
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carola Berking
- Department of Dermatology and Allergology, University Medical Center Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Martina T Zacher
- Department of Dermatology and Allergology, University Medical Center Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Wiebke Sondermann
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Niels Grabe
- BioQuant, Hamamatsu Tissue Imaging and Analysis Center (TIGA), University of Heidelberg, Heidelberg, Germany
| | - Theresa Steeb
- Department of Dermatology and Allergology, University Medical Center Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jochen Sven Utikal
- German Cancer Research Center, Skin Cancer Unit, University of Heidelberg, Mannheim, Germany
| | - Lars E French
- Department of Dermatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander H Enk
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
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