Berghout RM et al. 2007 "Evaluation of general practitioner's time investment during a store-and-forward teledermatology consultation."

Berghout RM, Eminovic N, de Keizer NF, et al. Evaluation of general practitioner's time investment during a store-and-forward teledermatology consultation. Int J Med Inf 2007;76 Suppl 3:S384-391.
"Background/objective: Introduction of teledermatology in general practice changes responsibilities and workloads of general practitioners (GPs) and dermatologists. We investigated the time investment of GPs as well as the relative share of the separate teledermatology [TD] activities during a store-and-forward teledermatology consultation. Methods: Sixty-four teledermatology consultations (eight GPs × eight patients) were conducted in a laboratory setting. The starting and ending time of each consultation and of five separate teledermatology activities were recorded by independent observers. The impact of several GP, patient and consultation characteristics on the calculated durations was investigated with repeated measurements analysis. Results: The mean duration of a teledermatology consultation was 11:32 min (range 7:02-26:44 min). The activity 'filling out electronic referral form' was the most time consuming teledermatology activity (3:12 min; 28%). Most time was spent on non-TD related consultation activities, e.g. taking medical history (4:43 min; 41%). The first of the eight consultations (p < 0.001) and consultations with female patients (p = 0.032) took on average more time than subsequent consultations (first consultations 13:42 min (male patients) and 17:03 min (female patients), and subsequent consultations 9:56 min (male patients) and 11:08 min (female patients).
Conclusions: Usage of store-and-forward teledermatology increases the average duration of a GP consultation with at least three and a half minutes. Further integration of teledermatology applications and electronic patients' records may reduce the total duration of a consultation and increase acceptance of eledermatology in general practice."

"To quantify the average time investment of GPs in a TD consultation (i.e. the duration of a TD consultation) and variations in that time investment among GPs. Also, to identify the relative share of the separate (TD) activities in the total duration of a TD consultation."

Type Clinic
Specialty care
Type Specific
not applicable
Type of Health IT
Context or other IT in place
Electronic medical records (EMR)
Workflow-Related Findings
"The average TD consultation took 11:32 min (range 7:02-26:44). Consultation length did not differ significantly between GPs (p = 0.548)."
"The activities that were most time consuming were 'filling out electronic referral form' (03:12 min; 28%) and 'other activities' (04:43 min; 41%). The other four activities lasted about 1min or less ('taking pictures' 01:12, 'transmitting pictures' 01:11, 'judging quality of pictures' 00:25, 'uploading pictures' 00:57). Total consultations on average took significantly more time when 'special situations' had occurred (mean 12:52 min (S.D. 04:05 min). Mean durations differed significantly between GPs for the activities 'taking pictures' (p < 0.001), 'judging quality of pictures' (p < 0.001) and 'filling out electronic referral form' (p = 0.016). The lowest and highest average durations of the five TD activities were related to different GPs."
The information added to the electronic referral form was judged by the consulting dermatologist to be good in 61%, neutral in 19% and poor in 20% of the consultations.
Study Design
Only postintervention (no control group)
Study Participants
The study participants included eight GPs and eight patients who conducted 64 teledermatology consultations.