Du Moulin MFMT et al. 2003 "The reliability of diagnosis using store-and-forward teledermatology."

Reference

Du Moulin MFMT, Bullens-Goessens YIJM, Henquet CJM, et al. The reliability of diagnosis using store-and-forward teledermatology. J Telemed Telecare 2003;9(5):249-252.

Abstract

"We compared diagnoses made by a teledermatologist from digital photographs and patient histories sent from general practitioners using a store-and-forward technique and those made by another dermatologist in a face-to-face consultation with the same patients. A total of 117 patients (mean age 47 years) were referred by 18 general practitioners for diagnosis of a skin condition. Between one and seven digital images were transmitted per case. In 31% of the cases, three images were transmitted. There was full concordance between store-and-forward and face-to-face diagnoses in 57 of 106 cases (54%); in 10 cases (9%) there was overlap between the differential diagnoses provided by the teledermatologist and the face-to-face consultant. Diagnostic categories with relatively high concordances were eczema and follicular eruptions. General practitioners need to be trained in the making of digital images and in giving a good patient history."

Objective

"To examine the reliability of diagnosis made using store-and-forward teledermatology."

Type Clinic

Primary care and specialty care

Type Specific

Primary care: family practice; Specialty: dermatology

Size

unknown

Type of Health IT

Telemedicine

Type of Health IT Functions

Patients were photographed by their general practitioner (GP) with a digital camera. Next GPs recorded the medical history, the present problem, medications, and symptoms on a Web-based form. Together with the digital images, these data were transmitted to the teledermatologist. All patients who were assessed by teledermatology also visited an outpatient clinic for a face-to-face consultation with one of eight dermatologists.

Workflow-Related Findings

"In 82% of cases GPs stated that the teleconsultation had met their expectations to a large extent. The most frequent therapy following teleconsultation was medication (70%)."

"The GPs mentioned exposure as a photographic obstacle in 24 of the 117 cases (22%); less frequently mentioned obstacles were finding the proper angle (6/117) and difficult location (5/117)."

"There was full diagnostic concordance between the SAF and FTF diagnosis in 57 of the 106 cases (54%); in an additional 10 cases (9%) there was partial concordance (i.e. overlap between the differential diagnosis provided by the teledermatologist and the FTF consultants). The diagnoses were discordant in 37% (39/106) of the cases; however, for 18% (7/39) of this discordance the SAF and FTF diagnoses belonged to the same diagnostic category."

Study Design

Only postintervention (no control group)

Study Participants

The study participants included 18 GPs, one teledermatologist, and 117 patients.