Mobile teledermatology: a feasibility study of 58 subjects using mobile phones

Comparison of Costs in Teledermatology Using PC and Camera Versus Smartphone

Introduction: One of the challenges faced by the Colombian Health System is to improve access to health services for the dispersed and isolated rural population, particularly in the field of dermatology. This article examines the implementation of a teledermatology service using a PC and camera versus smartphone technology. Methods: A total of 542 teledermatology visits were conducted, involving 478 patients, in addition to 64 visits for clinical follow-up for patients as per the dermatologist's recommendation. Out of the 478 patients, 461 met the inclusion criteria and agreed to participate in the study. The data collection instrument from the general practitioner or referring provider covered three consultation moments: (1) sending an initial consultation, (2) providing a response to the patient, and (3) sending a follow-up consultation. Seven hundred forty-seven records were completed by the general practitioner for the three consultation moments. Furthermore, 372 consultations were documented by the dermatologist or referring provider for two moments: (1) response to the initial consultation by the dermatologist, and (2) response to the follow-up consultation by the dermatologist. After validating the information reported in the instruments, a descriptive analysis of the data was conducted, utilizing absolute frequencies and percentages for qualitative variables and measures of central tendency (mean, median, standard deviation, and interquartile range) for quantitative variables. The data were analyzed from 747 records of the referring provider instrument related to 461 patients, between 18 and 98 years of age, with a predominantly female representation. Results: The results indicated that for teleconsultations conducted using a mobile device, the average total duration of the teleconsultation was longer on the traditional platform compared with the mobile device (13.03 vs. 8.27 min). Additionally, it was observed that the time taken to store, send, and capture a single image (clinical or dermoscopic) using the mobile device was three times lower than that on the conventional platform (25 vs. 75 s). Similar findings were noted for teleconsultations carried out by the dermatologist, predominantly utilizing a mobile device. The average consultation time was shorter for the mobile device compared with the traditional platform (8.14 vs. 12 min). Conclusions: The cost reduction suggests that the operation of the service is more efficient with smartphone technology in comparison to the use of a PC and camera. Teledermatology with smartphones provides a streamlined, efficient, and technically sound process for obtaining clinical and dermoscopic images.

Mobile app for comprehensive management of orthodontic patients with fixed appliances : Design and use

OBJECTIVES

This study aimed to design and implement a mobile phone application (app) aiming to enhance the cooperation and oral hygiene of orthodontic patients.

METHODS

An orthodontic app named "Labkhand" was designed by a team of orthodontists and programmers according to the needs and scheduled interventions for patients. The aim of this app was to obviate the orthodontic needs of patients by providing educational content in the form of texts and videos, oral hygiene reminders, appointment reminders, and nutrition reminders. It also enabled instant messaging and chatting between patients and dental personnel. In this study, 61 patients were monitored during their orthodontic treatment procedure. All patients were evaluated using a questionnaire with 7 questions before and after a 6-month treatment period. A total of 31 patients were instructed to use the app, while the other 30 patients received treatment without the app. The collected data were analyzed using paired t‑test and analysis of covariance (ANCOVA) test.

RESULTS

While the control group's questionnaire score remained almost the same (P > 0.05), the mean questionnaire score of patients in the intervention group significantly increased after using the app compared to the baseline scores acquired before using the app (P < 0.001). The greatest improvement was noted in topics related to "reminding of appointments", "general information about orthodontic treatment", and "oral hygiene maintenance and instructions". "Quality of services" and "patient-orthodontist communication" showed the least improvement in patient satisfaction.

CONCLUSIONS

The Labkhand orthodontic app has multiple functions and can obviate the needs of orthodontic patients easily and at a low cost.

Development of an mHealth App for Patients With Psoriasis Undergoing Biological Treatment: Participatory Design Study

BACKGROUND

In Denmark, patients with psoriasis undergoing biological treatment have regular follow-ups, typically every 3 months. This may pose a challenge for patients who live far away from the hospital. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis undergoing biological treatment because the disease course can be properly monitored. Despite recent developments in mHealth, the full potential of teledermatology remains to be tapped by newer, more attractive forms of services focused on patients' needs.

OBJECTIVE

This study aims to design and develop an mHealth app to support the self-management of patients with psoriasis using a participatory design.

METHODS

Using participatory design, we conducted 1 future workshop, 4 mock-up workshops, and 1 prototype test with patients and health care professionals to co-design a prototype. The process was iterative to ensure that all stakeholders would provide input into the design and outcome; this approach enabled continuous revision of the prototype until an acceptable solution was agreed upon. Data were analyzed according to the steps-plan, act, observe, and reflect-in the methodology of participatory design.

RESULTS

Health care professionals and patients emphasized the importance of a more patient-centered approach, focusing on the communication and maintenance of relationships. Patients perceived consultations to be impersonal and repetitive and wanted the opportunity to contribute to the agenda while attending a consultation. Patients also stated they would prefer not to attend visits in person every 3 months. On the basis of these findings, we designed an mHealth app that could replace in-person visits and support patients at in-person visits. Video consultations, self-monitoring, and registration of patient-reported outcome data were embedded in the app.

CONCLUSIONS

Using participatory design facilitated mutual learning and democratic processes that gave end users a significant influence over the solution. Despite the advantages of using participatory design in developing mHealth solutions, organizational conditions may still represent a barrier to the optimization of solutions.

Teledermatology in 2020: past, present and future perspectives

Born in 1995, teledermatology (TD) turns 25 years old today. Since then, TD evolved according to patients and physicians needs. The present review aimed to summarize all the efforts and experiences carried out in the field of TD and its subspecialties, the evolution and the future perspectives. A literature search was conducted in PubMed and Google Scholar. The state of the art of the "tele-dermo research" included TD and clinical trials, TD/TDS web platforms, TDS and artificial intelligence studies. Finally, the future perspective of TD/TDS in the era of social distancing was discussed. Using TD in specific situations adds several benefits including time-effectiveness of intervention and reduction in the waiting time for the first visit, reduced travel-costs, reduced sanitary costs, equalization of access from patient to specialistic consult. The communication technologies devices currently available can adequately support the growing needs of tele-assistance. A main limit is the current lack of a common clear European regulation for practicing TD, encompassing privacy issues and data management. The pandemic lockdown of 2020 has highlighted the importance of performing TD for all those patient, elderly and/or fragile, where the alternative would be no care at all. Many efforts are needed to develop efficient workflows and TD programs to facilitate the interplay among the different TD actors, along with practice guidelines or position statements.

Improving management of psoriasis patients receiving biological treatment: A qualitative approach

Aim

To investigate psoriasis patients’ and healthcare professionals’ experiences and perspectives of follow‐up consultations.

Design

A qualitative study with a phenomenological‐hermeneutic approach.

Method

Participant observations of consultations and semi‐structured interviews were conducted with patients receiving biological treatment, together with two focus groups with healthcare professionals, from June 2018–January 2019. Data were analysed using a qualitative structured approach based on Paul Ricoeur's philosophy of interpretation.

Results

Consultations had a strong biomedical and corrective approach focusing on lifestyle behaviour change, measurements and permanent routines. Healthcare professionals felt the need for enhanced competencies providing lifestyle behaviour change support and the possibility of providing patients more specific strategies. They were faced with a dilemma between lacking the right skills and having a professional duty. The frequent follow‐up visits did not fit in with the patients’ everyday lives.

Mobile Health App for Prostate Cancer Patients on Androgen Deprivation Therapy: Qualitative Usability Study

BACKGROUND

Androgen deprivation therapy (ADT) increases the risk of metabolic adverse effects among patients with prostate cancer. The transformative impact of mobile health (mHealth) apps may benefit men managing activity and nutrition at home.

OBJECTIVE

This study aimed to evaluate the usability and patient experience of a newly developed mHealth app among prostate cancer patients on ADT and physicians' beliefs about the potential benefits of using this app.

METHODS

This study took place over 2 months, beginning in March 2019. A sample of 5 patients (age 45-75 years) initiating ADT participated in a semistructured focus group discussion with a facilitator. The study participants also included 5 specialist physicians who provided in-depth interviews. An institutional review board-approved script was used to guide both the focus group and physician interviews. Usability was tested through specific scenarios presented to the patients, including downloading the mHealth app, entering information on physical activity and meals, and navigating the app. The focus group and interviews were audio recorded and transcribed. Content analysis was used to analyze the transcripts iteratively and exhaustively. Thematic discrepancies between reviewers were resolved through consensus.

RESULTS

The mean age of the patients was 62 years. This group included 4 White and 1 Latin American patients. The physician specialists included 2 urologists, 2 medical oncologists, and 1 radiation oncologist. Analyses revealed that the patients appreciated the holistic care enabled by the app. Difficulties were observed with registration of the app among 60% (3/5) of the patients; however, all the patients were able to input information about their physical activity and navigate the options within the app. Most patients (4/5, 80%) were able to input data on their recent meal. Among the health care physicians, the dominant themes reflected in the interviews included undermining of patients ability to use technology, patients' fear of technology, and concern for the ability of older patients to access technology.

CONCLUSIONS

The patients reported an overall positive experience of using an mHealth app to record and track diet and exercise. Usability was observed to be an important factor for adoption and was determined by ease of registration and use, intuitive appearance of the app, and focus on holistic cancer care. The physicians believed that the app was easy to use but raised concerns about usability among older men who may not typically use smartphone apps.

A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT

BACKGROUND

Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear.

OBJECTIVES

The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants' beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care.

DESIGN

Cluster randomised controlled trial.

SETTING

Thirty-five NHS hospital trusts/health boards/universities.

PARTICIPANTS

First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses.

INTERVENTION

Sites were randomly allocated to be 'intervention plus' or 'intervention light'. Participants at 'intervention plus' sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at 'intervention light' sites received usual care, including a dermatitis prevention leaflet.

MAIN OUTCOME MEASURE

The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up.

RANDOMISATION

Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm.

BLINDING

The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment.

NUMBERS ANALYSED

An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses.

RESULTS

The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained.

HARMS

No adverse events were reported.

LIMITATIONS

Only 44.5% of participants in the intervention plus arm accessed the behaviour change package.

CONCLUSION

The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group.

FUTURE WORK

Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN53303171.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 58. See the NIHR Journals Library website for further project information.

Patient satisfaction with dermatology teleconsultation by using MedX

BACKGROUND

The development of telecommunication has strongly affected comprehensive scientific disciplines, including medical sciences.

OBJECTIVE

This study aims to assess the patient satisfaction of the teleconsultation system used for the consultation of dermatological follow-up care.

METHODS

The study was performed cross sectional patient satisfaction survey method conducted between February and April 2017 to determine patient satisfaction using MedX teleconsultation system. The patient sample of the current study was recruited from cosmetic laser clinic, Wanfang and Taipei Medical University hospital. The study was performed on 32 patient (n = 32) participants. All of them were at least university graduate. Consultants and patients were handled using the Android-based MedX mobile application, which is available through an application for Google Android cellular telephones. Its application consists of a demographic information, structured step-by-step questionnaire, essential medical information about each patient, and digital images of skin lesions.

RESULTS

28 patients completed the questionnaire. The mean ± SD age of the patients was 27.25 ± 4.039 years; 78.6% were women. The study shows that respondents have reported a high level (85.8%) of mean overall satisfaction for the teleconsultation service. The usability of the system has highest satisfaction rate of 90.5% among the other subscales especially in terms of data transfer and data displayed. Responses of the patient satisfaction questionnaire were analyzed by age and gender, no statistically significant difference between the variables was found.

CONCLUSION

Patients have shown high satisfaction with teleconsultation service and it is well accepted in the management of cosmetic dermatology service. In the future, MedX application can be integrated into other instant messaging applications such as Line, thus allowing doctors and patients to easily communicate with each other.

On Using a Mobile Application to Support Teledermatology: A Case Study in an Underprivileged Area in Colombia

Background

The use of mobile applications in dermatology to support remote diagnosis is gaining acceptance, particularly in rural areas, where dermatology services are commonly managed by healthcare personnel with no specialty training. Moreover, ontologies—sets of concepts that represent knowledge in a given domain—are increasingly being used to support medical diagnosis. A specific case is ONTODerm: an ontology to aid dermatological diagnosis. However, there is little information on the combined use of mobile applications and ontologies as support solutions in dermatology.

Objective

Assessing the reliability of ONTODerm as a tool to support remote dermatological diagnosis when used together with a mobile dermatological application in underprivileged areas.

Methods

A mobile application that allows characterization of skin lesions was developed, and the information about the lesions was sent to ONTODerm. An exploratory study was conducted in a remote area without access to a dermatologist. A total of 64 dermatological queries were recorded in the application and consulted with ONTODerm. Later, an experienced dermatologist evaluated the characterization and diagnosis of each query to determine the accuracy of the system.

Results

The results showed that the probability of obtaining a correct diagnosis was between 64.4% and 85.6% with a confidence interval of 95%. A higher accuracy rate was obtained when the skin lesion occurred on the face or when its border was categorized as poorly demarcated.

Conclusions

This study demonstrates the implementation of a teledermatology strategy based on mobile applications and domain ontology-driven knowledge base to provide timely assistance to healthcare professionals. This approach was found to be pertinent in the Colombian rural context, particularly in forest regions, where dermatology specialists are not available. The results of this article do not represent a final validation of the proposed approach; they suggest how the ontology can be improved to effectively support medical staff in marginalized regions.

Get the Picture: A Pilot Feasibility Study of Telemedical Wound Assessment Using a Mobile Phone in Cardiology Patients

BACKGROUND

Postprocedural complications after elective cardiac interventions include hematomas and infections. Telemedical wound assessment using mobile phones with integrated cameras may improve quality of care and help reduce costs.

AIMS

We aimed to study the feasibility of telemedical wound assessment using a mobile phone. The primary aim was the number of patients who were able to upload their pictures. Secondary aims were image interpretability, agreement between nurse practitioners, and patient evaluation of the intervention.

METHODS

This is a prospective study of all consecutive patients who underwent an elective cardiac intervention. Patients were instructed to photograph their wound or puncture site after hospital discharge and upload the pictures to a secure email address 6 days after hospital discharge. Received photos were assessed by 2 nurse practitioners. The intervention was evaluated using a peer-reviewed questionnaire and photo assessment scheme.

RESULTS

In total, 46 eligible patients were included in the study, with 5 screen failures (eg, clinical stay ≥ 6 days) and 1 patient lost to follow-up. Thirty-three of 40 patients (83%) were able to upload their pictures. Smartphone users were more successful in uploading their pictures compared with feature phone users (93% vs 55%, P < .01). Eighty-eight percent of the clinical pictures were interpretable. The interobserver variability had an agreement between 93% and 97%.

CONCLUSIONS

Patients are able to take and upload the mobile clinical photos to the secure email address, and the vast majority was interpretable. Smartphone users were more successful than feature phone users in uploading their pictures. The interobserver variability was good.

Patient and Provider Satisfaction with Teledermatology

BACKGROUND

There is little research comparing dermatologist and patient satisfaction with in-person, store-and-forward, and live interactive examinations.

OBJECTIVE

To compare satisfaction with in-person examinations to store-and-forward and live interactive consultations having two types of video.

METHODS

A controlled study was conducted where patients referred for dermatology consultations were examined in-person, by video, and by store-and-forward methods. Video changed between compressed and uncompressed on alternate clinics. Patients and dermatologists rated encounters after each examination. Dermatologists doing store-and-forward evaluations rated the quality of information provided. After experiencing all methods patients ranked their preferences. Dermatologists ranked their preferences at the end of the study.

RESULTS

In-person examinations were preferred by both patients and dermatologists. Overall, satisfaction with teledermatology was still high. Patients were evenly divided in preferring store-and-forward workups or live interactive video. Dermatologists were also divided on store-and-forward and uncompressed video, but tended toward the latter. Compressed video was the least preferred method among dermatologists.

LIMITATIONS

Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice.

CONCLUSIONS

Patients and dermatologists prefer in-person examinations and diverge on preferring store-and-forward and live interactive when video is not compressed. The amount of video compression that can be applied without noticeable image degradation is a question for future research.

Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review

Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation. The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically. The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings. The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.

Electronic Follow-Up of Developing World Cleft Patients: A Digital Dream?

OBJECTIVE

To identify potential access to telemedicine follow-up of children with clefts operated on a humanitarian mission.

METHODS

A cross-sectional study of parents of children presenting to a humanitarian cleft lip and palate mission in a Provincial Hospital in the Philippines. A purpose designed questionnaire was used to assess access to electronic and digital resources that could be used to aid follow-up. Forty-five (N = 45) parents of children having primary cleft lip and or palate surgery participated. There were no interventions. Access to the Internet was through Parent Perceived Affordability of Internet Access and Parent Owned Devices.

RESULTS

Thirty-one (N = 31) respondents were female. There was 93% mobile phone ownership. The mean distance traveled to the clinic was 187 km. Majority (56%) were fluent in English. Thirty-one percent accessed the Internet daily. Sixteen percent reported use of e-mail. Fifty-one percent accessed the Internet on a mobile device, and short message service use was the most affordable means of communication.

CONCLUSIONS

Due to perceived unaffordability and low levels of access to devices with cameras and the Internet, as well as issues with privacy, we cannot recommend relying on electronic follow-up of patients in the developing world.

A systematic review of satisfaction with teledermatology

Background The two most commonly used modalities of teledermatology (TD) are store-and-forward (SF) and live-interactive (LI) TD. Existing studies have not compared these tools with respect to patient and provider satisfaction. Objective To systematically review all published studies of patient and provider satisfaction with SF and LI TD. Methods PubMed, EMBASE, and Cochrane databases were systematically searched for studies on provider or patient satisfaction with SF or LI TD between January 2000 and June 2016. Results Forty eligible studies were identified: 32 with SF TD, 10 with LI TD, and 2 evaluating both. With SF TD, 96% of studies assessing patient satisfaction and 82% of studies assessing provider satisfaction demonstrated satisfaction ( n = 24 and 17, respectively). With LI TD, 89% of studies assessing patient satisfaction and all studies assessing provider satisfaction revealed satisfaction (n = 9 and 6, respectively). Conclusion Patients and providers are satisfied with both SF and LI TD. Studies assessing satisfaction with LI have not been conducted in recent years, and have only been conducted in limited geographic patient populations. Further research assessing satisfaction with TD will help address any dissatisfaction with its uses and allow for increased support and funding of future programmes.

A prototype mobile application for triaging dental emergencies

BACKGROUND

Evidence suggests that dental emergencies are likely to occur when preferred care is less accessible. Communication barriers often exist that cause patients to receive suboptimal treatment or experience discomfort for extended lengths of time. Furthermore, limitations in the conventional approach for managing dental emergencies prevent dentists from receiving critical information before patient visits.

METHODS

The authors developed a mobile application to mediate the uncertainty of dental emergencies. The development and study consisted of a needs analysis and quality assessment of intraoral images captured by smartphones, prototype development, refining the prototype through usability inspection methods, and formative evaluation through usability testing with prospective users.

RESULTS

The developed application successfully guided all users through a series of questions designed to capture clinically meaningful data by using familiar smartphone functions. All participants were able to complete a report within 4 minutes, and all clinical information was comprehended by the users.

CONCLUSIONS

Patient-provided information accompanied by high-resolution images may help dentists substantially in predicting urgency or preparing necessary treatment resources. The results illustrate the feasibility of patients using smartphone applications to report dental emergencies. This technology allows dentists to assess care remotely when direct patient contact is less practical.

PRACTICAL IMPLICATIONS

This study's results demonstrate that patients can use mobile applications to transmit clinical data to their dentists and suggest the possibility of expanding the use of mobile applications to enhance access to routine and emergency dental care. The authors addressed how to enable patients to communicate emergency needs directly to a dentist while obviating patient emergency department visits.

Practice Guidelines for Teledermatology

Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.

A Prospective Study of Mobile Phones for Dermatology in a Clinical Setting

We evaluated the accuracy of diagnoses made from pictures taken with the built-in cameras of mobile phones in a ‘real-life’ clinical setting. A total of 263 patients took part, who photographed their own lesions where possible, and provided clinical information via a questionnaire. After the teledermatology procedure, each patient was examined face-to-face and a gold standard diagnosis was made. The telemedicine data and pictures were diagnosed by 15 dermatologists. The 299 cases contained 1–22 clinical images each (median 3). Nine dermatologists finished all the cases and the remaining six completed some of them, thus providing 2893 decisions. Overall, 61% of all cases were rated as possible to diagnose and of those, 80% were correct in comparison with the face-to-face diagnosis. Image quality was evaluated and the median was 5 on a 10-point scale. There was a significant correlation between the correct diagnosis and the quality of the photographs taken ( P & 0.001). In nearly two-thirds of all cases, a teledermatology diagnosis was possible; however, there was insufficient information to make a telemedicine diagnosis in about one-third of the cases. If applied carefully, mobile phones could be a powerful tool for people to optimize their health care status.

Smartphone patient monitoring post-laser resurfacing

BACKGROUND/OBJECTIVES

Patients should be monitored post-laser resurfacing for reassurance and the early detection of adverse events. Smartphone monitoring in the post-laser resurfacing setting is an efficient and convenient tool that is well accepted by patients and dermatologists. The objective was to identify the benefits and barriers of, and patient attitudes towards, smartphone monitoring in the post-laser resurfacing setting.

METHODS

A retrospective audit of 123 laser resurfacing patients was undertaken to determine the characteristics of this population. A web-based survey was used to determine patients' attitudes towards smartphone monitoring.

RESULTS

The commonest indications for laser resurfacing were acne scarring and photoageing rejuvenation. 88% of patients either had no adverse outcomes or expected post-laser resurfacing side-effects such as erythema. 12% developed adverse effects requiring intervention. The survey showed that all patients who had used the smartphone monitoring service felt it was a positive initiative for post-laser patients. Of note, most patients not using the smartphone review service were simply unaware of its existence. Biases may have been introduced as staff were less likely to promote the review service to patients undergoing lower intensity procedures.

CONCLUSIONS

Smartphone monitoring post-laser resurfacing is an efficient and convenient alternative to face-to-face review for both patients and dermatologists. As technology improves and patients' expectations increase we expect more patients will request teledermatology reviews in order to easily and rapidly access medical advice.

Impact of store-and-forward (SAF) teledermatology on outpatient dermatologic care: A prospective study in an underserved urban primary care setting

BACKGROUND

The clinical value of teledermatology in the primary care setting remains relatively unknown.

OBJECTIVE

We sought to determine the impact of teledermatology on outpatient diagnosis, management, and access to dermatologic care in a resource-poor primary care setting.

METHODS

We performed a prospective study of store-and-forward teledermatology consults submitted between January and November 2013 from 11 underserved clinics in Philadelphia to the University of Pennsylvania using mobile devices and the Internet. We assessed diagnostic and management concordance between primary care providers and dermatologists, time to consult completion, anticipated level of dermatology input in the absence of teledermatology, and number of consults managed with teledermatology alone.

RESULTS

The study included 196 consults encompassing 206 dermatologic conditions. Diagnoses and management plans of primary care providers and dermatologists were fully concordant for 22% and 23% of conditions, respectively. The median time to consult completion was 14 (interquartile range 3-28) hours. At least 61% of consults would not otherwise have received dermatology input, and 77% of consults were managed with teledermatology alone.

LIMITATIONS

Lack of a diagnostic gold standard, limited patient follow-up, and uncertain generalizability are limitations.

CONCLUSION

Teledermatology is an innovative and impactful modality for delivering dermatologic care to outpatients in resource-poor primary care settings.

Teledermatology

This article provides an overview of teledermatology with an emphasis on the evidence most relevant to referring clinicians, who are often primary care clinicians. Discussion includes the different modalities used for teledermatology and their diagnostic reliability, diagnostic accuracy, impact on in-person dermatology visits, clinical outcomes, and user satisfaction.

The acceptance of mobile teledermoscopy by primary care nurse practitioners in the state of Arizona

PURPOSE

To conduct a pilot survey to assess acceptance of mobile teledermoscopy (MTD) by primary care nurse practitioners (NPs) working in Arizona.

DATA SOURCES

Sixty-two participants recruited from NP and academic listservs in Arizona completed an online survey prefaced by a MTD definition, device photographs, and a practice case, followed by 33 items measuring Teledermatology Technology Acceptance Model (TeleTAM) constructs.

CONCLUSIONS

Participants were highly interested in using MTD to assess skin lesions. They perceived MTD utility to greatly improve diagnosis and positively impact their practice. Most participants had never used MTD, but had high mean scores for MTD attitude and moderate scores for MTD perceived ease of use, perceived use, and facilitators of MTD. They had moderate scores for intention to use MTD. The construct facilitators (organizational infrastructure) were most strongly associated with intention to use MTD. Cronbach alphas were 0.70 or higher for all subscales except compatibility and habit.

IMPLICATIONS FOR PRACTICE

Moderate acceptance of MTD may reflect NPs' knowledge of the technology, self-confidence for using it, or MTD financial constraints. Future research will address these factors to foster use of MTD by NPs, thereby improving patients' access to early skin lesion assessment and diagnosis.

A Survey of Mobile Phone Sensing, Self-Reporting, and Social Sharing for Pervasive Healthcare

The current institution-based model for healthcare service delivery faces enormous challenges posed by an aging population and the prevalence of chronic diseases. For this reason, pervasive healthcare, i.e., the provision of healthcare services to individuals anytime anywhere, has become a major focus for the research community. In this paper, we map out the current state of pervasive healthcare research by presenting an overview of three emerging areas in personalized health monitoring, namely: 1) mobile phone sensing via in-built or external sensors, 2) self-reporting for manually captured health information, such as symptoms and behaviors, and 3) social sharing of health information within the individual's community. Systems deployed in a real-life setting as well as proofs-of-concept for achieving pervasive health are presented, in order to identify shortcomings and increase our understanding of the requirements for the next generation of pervasive healthcare systems addressing these three areas.

Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice

Telemedicine is the use of telecommunications technology to support health care at a distance. Technological advances have progressively increased the ability of clinicians to care for diverse patient populations in need of skin expertise. Dermatology relies on visual cues that are easily captured by imaging technologies, making it ideally suited for this care model. Moreover, there is a shortage of medical dermatologists in the United States, where skin disorders account for 1 in 8 primary care visits and specialists tend to congregate in urban areas. Even in regions where dermatologic expertise is readily accessible, teledermatology may serve as an alternative that streamlines health care delivery by triaging chief complaints and reducing unnecessary in-person visits. In addition, many patients in the developing world have no access to dermatologic expertise, rendering it possible for teledermatologists to make a significant contribution to patient health outcomes. Teledermatology also affords educational benefits to primary care providers and dermatologists, and enables patients to play a more active role in the health care process by promoting direct communication with dermatologists.

Reliability and validity of mobile teledermatology in human immunodeficiency virus-positive patients in Botswana: a pilot study

IMPORTANCE

Mobile teledermatology may increase access to care.

OBJECTIVE

To determine whether mobile teledermatology in human immunodeficiency virus (HIV)-positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist.

MAIN OUTCOMES AND MEASURES

We calculated the κ coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis.

RESULTS

The κ coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (-0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The κ coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively.

CONCLUSIONS AND RELEVANCE

Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.

Influencing dressing choice and supporting wound management using remote 'tele-wound care'

This article describes a local involvement in a project to evaluate a remote system of wound management, incorporating the use of digital and mobile technology. It outlines how this involvement influenced the current system of 'tele wound care' (remote wound management) in a large community organisation. The system allows remote wound assessment, management advice and ongoing monitoring of wounds to ensure that the dressing choice remains appropriate and that timely wound care support can be provided to community nurses, practice nurses and GPs.

Consumer preferences for telemedicine devices and services in South Korea

OBJECTIVE

The scope of healthcare has been expanding from caring for sick people to keeping people from becoming sick, and telemedicine will play a significant role in this new healthcare paradigm. This study investigated consumer preferences and willingness to pay for attributes of telemedicine services in South Korea. A market simulation was conducted to examine the market shares of alternative services and their relationships to the perceived usefulness of service types and preferred device types.

MATERIALS AND METHODS

Using a conjoint survey, we collected data on consumer preferences for six telemedicine service attributes. Data analysis used the Bayesian mixed logit model. The market simulation estimated the probabilities of a specific service alternative being chosen using estimated model coefficients.

RESULTS

Wearable devices were the most preferred, followed by smart-home and smartphone devices. Consumers perceived managing blood glucose to be the most useful telemedicine service, followed by monitoring oxygen saturation and blood pressure. The market simulation indicated that consumer preferences for device types were associated with the types of chronic diseases for which management through telemedicine services is perceived to be useful.

CONCLUSIONS

As the focus of healthcare moves from treating patients to keeping individuals healthy, a key factor for the successful deployment of telemedicine services is understanding consumer perceptions and attitudes. The results of this study revealed the dynamics of consumer preferences with regard to service attributes.

Mobile teledermatology--patient satisfaction, diagnostic and management concordance, and factors affecting patient refusal to participate in Saudi Arabia

We evaluated the use of a 4G smart phone for mobile teledermatology. A dermatologist took pictures of skin images with a mobile phone (8 Mpixel camera resolution) and made a face-to-face diagnosis. The images were transmitted to a second dermatologist who viewed them on a similar mobile phone and made an independent diagnosis for comparison. Images were taken and transmitted only after receiving informed consent from the patients. A total of 166 consecutive patients were included in the study (97 male and 69 female). A questionnaire to assess patient satisfaction was administered to each patient. Most of the responders were highly satisfied with teledermatology. However, 23 patients (14%) refused photography of the skin lesions (21 female and 2 males). The main reasons for refusal to be photographed were stated as social or religious. The broad categorical diagnostic and management concordance (i.e. when considering at least one of the diagnoses to be similar) was 95%. Specific diagnostic concordance varied according to the disease. The average kappa coefficient was 0.66 for diagnostic concordance and 0.82 for management concordance. Refusal to be photographed--a problem not limited to teledermatology--needs to be considered when designing teledermatology protocols for larger scale implementation in areas like the Middle East.

Teledermatology update: Mobile teledermatology

Mobile teledermatology is a relatively recent modification of teledermatology, which involves using mobile platforms like cellular phones to transmit images and data for the purpose of teleconsultations. With the rapidly improving quality of smart phone cameras combined with easier access to mobile internet, mobile teledermatology is emerging as a feasible and cost-effective method for teledermatology practice. Mobile teledermatology has shown good results in concordance studies comparing it to face-to-face consultations. Mobile teledermatology can be used for most types of clinical dermatology cases. Mobile teledermatology has been found to be useful in diagnosis, screening and triage of skin lesions including skin cancers. It is also useful as a tool to follow up patients with chronic dermatological problems like psoriasis and chronic wounds. The obvious advantage of mobile teledermatology is it’s cost-effectiveness and the fact that access to expert dermatology care is made easier for patients especially in remote areas. Further research is however required to standardize protocols for mobile teledermatology. Collaborative research among people working in this field would be very useful in this standardization and would help in optimizing the opportunities provided by this interesting tool. This article gives a brief overview of mobile teledermatology including definitions, tools involved, indications, limitations and future applications.

Optimal protocol for teleconsultation with a cellular phone for dentoalveolar trauma: an in-vitro study

PURPOSE

Dental trauma is frequently unpredictable. The initial assessment and urgent treatment are essential for dentists to save the patient's teeth. Mobile-phone-assisted teleconsultation and telediagnosis for dental trauma could be an aid when a dentist is not available. In the present in-vitro study, we evaluated the success rate and time to transfer images under various conditions.

MATERIALS AND METHODS

We analyzed the image quality of cameras built into mobile phones based on their resolution, autofocus, white-balance, and anti-movement functions.

RESULTS

The image quality of most built-in cameras was acceptable to perform the initial assessment, with the autofocus function being essential to obtain high-quality images. The transmission failure rate increased markedly when the image size exceeded 500 κB and the additional text messaging did not improve the success rate or the transmission time.

CONCLUSION

Our optimal protocol could be useful for emergency programs running on the mobile phones.

Application of mobile teledermatology for skin cancer screening

BACKGROUND

With advancements in mobile technology, cellular phone-based store-and-forward teledermatology may be applied to skin cancer screening.

OBJECTIVE

We sought to determine diagnostic and management concordance between in-person and teledermatology evaluations for patients at skin cancer screening whose clinical images and history were transmitted through mobile phones.

METHODS

A total of 86 patients with 137 skin lesions presented to a skin cancer screening event in California. These patients' clinical history and skin images were captured by a software-enabled mobile phone. Patients were assessed separately by an in-person dermatologist and a teledermatologist, who evaluated the mobile phone-transmitted history and images. Diagnostic and management concordance was determined between the in-person and teledermatology evaluations.

RESULTS

The primary categorical diagnostic concordance was 82% between the in-person dermatologist and the teledermatologist (95% confidence interval 0.73-0.89), with a Kappa coefficient of 0.62 indicating good agreement. The aggregated diagnostic concordance between the in-person dermatologist and the teledermatologist was 62% (95% confidence interval 0.51-0.71), with Kappa coefficient of 0.60 indicating good agreement. Management concordance between the in-person dermatologist and the teledermatologist was 81% (95% confidence interval 0.72-0.88), with a Kappa coefficient of 0.57, which indicates moderate agreement between the dermatologists. Multivariate analysis showed that older age and presentation of atypical nevus were significantly associated with disagreement in diagnosis between the teledermatologist and in-person dermatologist, after adjusting for other factors.

LIMITATIONS

Dermatoscopic images were not captured via mobile phones, which might improve diagnostic accuracy.

CONCLUSION

Mobile teledermatology using cellular phones is an innovative and convenient modality of providing dermatologic consultations for skin cancer screening.

Validity of Cobb angle measurements using digitally photographed radiographs

BACKGROUND CONTEXT

Advances in technology are influencing the way that medical information is archived and shared. Considering that an estimated two-thirds of the world has little or no orthopedic care, high demand exists for adequate consultation regarding diagnostic images in orthopedic specialties.

PURPOSE

To validate the use of photographed scoliosis films for the accurate interpretation of Cobb angles.

STUDY DESIGN

Retrospective review.

PATIENT SAMPLE

Thirty scoliosis radiographs.

OUTCOME MEASURE

Cobb angle.

METHODS

Thirty scoliosis radiographs were photographed using a digital camera from a straight and a 45° angle position. Cobb angles were then measured on the digital images using standard measurement software. Comparison was made between two types of curves: convex and concave, relative to the left side (side for the angled position).

RESULTS

There was excellent reproducibility between the measurements of the conventional radiographs and the photographs taken from a straight on position, p value of .97 for convex curves and p value of .98 for concave curves. Photographs taken from a 45° angle significantly increased the magnitude of the curve convex to the angle (p=.001).

CONCLUSION

Sharing photographs of scoliosis radiographs can be done with reliability if the image is taken directly in front of the viewbox rather than at an oblique angle; pictures taken at oblique angles are prone to misinterpretation of curve magnitude.

Service design attributes affecting diabetic patient preferences of telemedicine in South Korea

OBJECTIVE

Attempts to introduce telemedicine in South Korea have failed mostly, leaving critical questions for service developers and providers about whether patients would be willing to pay for the service and how the service should be designed to encourage patient buy-in. In this study, we explore patients' valuations and preferences for each attribute of telemedicine service for diabetes management and evaluate patient willingness to pay for specific service attributes.

MATERIALS AND METHODS

We conducted a conjoint survey to collect data on patients' stated preferences among telemedicine service alternatives. The alternatives for diabetes-related service differed in 10 attributes, including those related to price, type of service provider, and service scope. To estimate the relative importance of attributes, patients' willingness to pay for each attribute, and their probable choice of specific alternatives, we used a rank-ordered logit model. A total of 118 respondents participated in the survey.

RESULTS

All 10 attributes significantly affected patients' valuations and preferences, and demographic and disease characteristics, such as existence of complications and comorbidities, significantly affected patients' valuations of the attributes. Price was the most important attribute, followed by comprehensive scope of service, the availability of mobile phone-based delivery, and large general-hospital provided services.

CONCLUSIONS

The study findings have significant implications for adoption policy and strategy of telemedicine in diabetes management care. Further, the methodology presented in this study can be used to draw knowledge needed to formulate effective policy for adoption of the necessary technology and for the design of services that attract potential beneficiaries.