Can Teledermatology Support Patient Care?

Image Credit: © Nuttapong punna

Despite dermatological complaints accounting for roughly 1 in 10 emergency department (ED) presentations,¹ a recent review found limited opportunities exists in teledermatology. The review argued that access to teledermatology would not only enable patients to receive a diagnosis and treatment plan in an efficient way, but also would improve dermatology access overall in communities with limited resources.²

Efficacy and Accuracy

The researchers behind this review found 4 eligible studies (n=660 patients) providing data on the subject, all based in the Australian healthcare system.They found previous trials have shown success in both store-and-forward (SAF) and real-time (RT) teledermatology,^3,4 with 3 of 4 studies practicing SAF and 1 testing RT. 

The review found that 50% of referrals as a result of teledermatology were converted to outpatient review, reducing the need for costly hospital admissions. A study out of France included in the review revealed that ED physicians recommended admission more frequently (8.2% vs. 7.2%, p < 0.001), while dermatologists chose to discharge patients more often (46.8% vs. 39.1%, p < 0.001).⁴

Researchers found that 1 study reported up to 98% diagnostic concordance using SAF technology in ED. Furthermore, they discovered the management concordance between the teledermatologists and in-person dermatologists were complete agreement in 96% of cases (n=48).⁵

Quality and Security

The review noted that over 80% of images included were sent with “adequate resolution.”Researchers suggested that workstations on wheels (WOW) could be utilized as a solution to managing dermatological conditions in contexts where specialists are scarce, as the technology is equipped with high-definition cameras. In addition to this, they mentioned that smartphone devices with purpose-built apps, such as MedSync, that integrate with electronic medical records and offer confidential image capture and storage, may be an option. They did, however, recognize that this would require a level of comfortability with the app for both the employees and the patient.

While the researchers found many SAF studies used an internal teledermatology email to receive consults, they observed that referring clinicians sometimes sent correspondence through personal email accounts. “An important consideration is ensuring clinical information is quickly and easily importable to the patient file for contemporaneous documentation, and deleted off personal devices,” they wrote. They mentioned that the software to accomplish this already exists, but licensing can be expensive, and hospitals must be willing to invest in the software license as well as increased data storage to accommodate images.

Conclusion

Overall, this review found that teledermatology allows patients to receive a diagnosis and treatment plan in the time they are waiting in the ED, which could optimize patient outcomes, reduce admissions, and improve universal dermatology access. They noted that patient preference for teledermatology over usual care ranged from 38% to 86%, with factors such as longer waitlists and travel to support the technology influencing satisfaction.

Limitations

Although this review gave thoughtful insight into the world of teledermatology, the researchers found only 44% of teledermatology referrals were from ED doctors across all 4 studies. They also mentioned that there is no literature on the use of WOW’s in the ED for teledermatology consultation, which have mainly been studied for use in the context of telestroke. Researchers noted that a lack of follow-up data on implementation of treatment plans based on teledermatology exists, and without this longitudinal data, there is a risk of inadequate patient response.

References

1. Jack AR, Spence AA, Nichols BJ, et al. Cutaneous conditions leading to dermatology consultations in the emergency department. West J Emerg Med. 2011;12(4):551-555. doi:10.5811/westjem.2010.4.1653
2. Xie, D. and Sullivan, J. Teledermatology in Australian public hospital emergency departments: A review. AustralasJ Dermatol. https://doi.org/10.1111/ajd.14327
3. Miller BJ, Finnane A, Vun Y, et al. Real-time teledermatology clinics in a tertiary public hospital: A clinical audit.Australas J Dermatol. 2020;61(4):e383-e387. doi:10.1111/ajd.13322
4. Duong TA, Cordoliani F, Julliard C, et al. Emergency department diagnosis and management of skin diseases with real-time teledermatologicexpertise. JAMA Dermatol. 2014;150(7):743-747. doi:10.1001/jamadermatol.2013.7792
5. Muir J, Xu C, Paul S, et al. Incorporating teledermatology into emergency medicine. Emerg Med Australas. 2011;23(5):562-568. doi:10.1111/j.1742-6723.2011.01443.x