1
|
Fujimoto A, Hayashi R, Iguchi S, Abe R. Can dermatologists reach their full potential in teledermatology? A validation study of diagnostic performance of skin diseases in live video conferencing teledermatology. J Dermatol 2024. [PMID: 38507330 DOI: 10.1111/1346-8138.17197] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/03/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
The diagnostic accuracy rate of live videoconferencing (LVC) teledermatology, by board-certified dermatologists compared to non-dermatologists has not yet been fully investigated. The aim of this study was to compare the diagnostic accuracy of board-certified dermatologists, dermatology specialty trainees, and board-certified internists in LVC teledermatology. We examined the diagnostic accuracy of clinicians from different specialties in diagnosing the same group of patients. The clinicians were isolated from each other during the diagnosis process. We enrolled 18 volunteer physicians (six board-certified dermatologists, six dermatology specialty trainees, and six board-certified internists) who reviewed the skin conditions of 18 patients via LVC teledermatology. The diagnostic accuracy of the participating physicians was evaluated using the final diagnosis as the reference standard. The diagnostic accuracy averages were compared according to the physicians' specialties and disease categories. The mean ± standard deviation diagnostic accuracy of the most detailed level diagnosis was 83.3% ± 3.5% (range, 77.8%-89.0%) for board-certified dermatologists, 53.7 ± 20.7% (range 27.8%-77.8%) for dermatology specialty trainees, and 27.8 ± 5.0% (range, 22.2%-33.3%) for board-certified internists. Board-certified dermatologists showed significantly higher diagnostic accuracy, not only against board-certified internists (p < 0.0001) but also against dermatology specialty trainees (p < 0.05). Disease categories with high accuracy rates (≥80%) only by board-certified dermatologists were inflammatory papulosquamous dermatoses (87.5%), compared to 58.3%, and 20.8% for dermatology specialty trainees and board-certified internists respectively). For inflammatory erythemas and other reactive inflammatory dermatoses the accuracy rates for board-certified dermatologists, dermatology specialty trainees, and board-certified internists were 83.3%, 33.3%, 8.3% respectively; for melanoma in situ neoplasms, 83.3%, 50.0%, 66.7% respectively), and for genetic disorders of keratinization 83.3%, 33.3%, and 0% respectively). Our findings showed that board-certified dermatologists may have high diagnostic accuracy with practical safety and effectiveness in LVC teledermatology.
Collapse
Affiliation(s)
- Atsushi Fujimoto
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Medical Bit Valley Aile Home Clinic, Nagaoka, Japan
| | - Ryota Hayashi
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Seitaro Iguchi
- Department of Community Medicine, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
2
|
Lee CJ, Boyce A, Chequer de Souza J, Evans R. Store-and-forward (asynchronous) doctor-to-dermatologist non-skin cancer specific teledermatology services in Australia: A scoping review. Australas J Dermatol 2024; 65:37-48. [PMID: 37929627 DOI: 10.1111/ajd.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
Store-and-forward teledermatology (SAFT) has become increasingly popular as a means to increase access to specialist care and address healthcare disparities such as those experienced by rural communities. A contemporary systematic overview of the Australian SAFT services and outcomes for all dermatological conditions is missing. This scoping review provides an overview of Australian SAFT models. Twelve studies were identified through web databases, grey literature sites and reference lists of eligible articles. Eligibility criteria included studies evaluating doctor-to-dermatologist Australian SAFT services provided to Australians for all skin conditions but excluded the studies that solely focused on skin cancers. Data on study design, setting, population, SAFT model, referral characteristics, patient, and general practitioner perspectives, diagnostic concordance, and measured outcomes such as follow up, investigation and waiting time were extracted. Quality of the included studies was assessed using CASP tools. Synthesis reveals that SAFT can be used for patients with any dermatological condition, provides more accurate diagnostics compared to cases without dermatologist input, may reduce waiting times for dermatological expertise, and users generally had positive experiences with SAFT. Although results are positive, this review reveals the heterogenous nature of the literature on SAFT in Australia and a need to establish a uniform approach to assessing the outcomes and impacts of such services.
Collapse
Affiliation(s)
- Celine Jessica Lee
- College of Medicine and Dentistry, James Cook University, Queensland, Townsville, Australia
| | - Aaron Boyce
- Department of Dermatology, Townsville University Hospital, Douglas, Queensland, Australia
| | - Julia Chequer de Souza
- College of Medicine and Dentistry, James Cook University, Queensland, Townsville, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, Queensland, Townsville, Australia
| |
Collapse
|
3
|
Reinders P, Augustin M, Kirsten N, Fleyder A, Otten M. Digital health interventions in dermatology-Mapping technology and study parameters of systematically identified publications. J Eur Acad Dermatol Venereol 2023; 37:2440-2449. [PMID: 37528462 DOI: 10.1111/jdv.19392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023]
Abstract
Digital health interventions (DHI) potentially improve the efficiency and effectiveness of dermatological care. Currently, an overview clustering and characterizing the evidence on DHIs is missing. This systematic mapping of the literature aims to analyse published research on DHIs in dermatology to identify trends and gaps in research. For this purpose, a systematic search of the MEDLINE database was conducted in August 2022 to identify original publications on DHIs in dermatology. Data on country, targeted audience, DHI category, indication, outcome parameter and study design were extracted. Out of 12,009 records identified in MEDLINE, 403 studies were included in the final analysis. Studies on DHIs mainly performed in western countries, headed by the United States (n = 133), Germany (n = 32) and Spain (n = 23). Of all identified DHIs, 261 targeted healthcare providers (HCP), 66 clients (e.g. patients, caregivers, healthy individuals) and 67 both clients and HCPs. A majority of DHIs focussed on establishing a diagnosis (n = 254). Every other study analysed store-and-forward teledermatology (n = 187), followed by artificial intelligence applications for image analysis (n = 65). The most often analysed DHI category for clients was a support of health behaviour change (n = 31). Monitoring of clients was targeted by 77 studies. Skin cancer (n = 148), wounds (n = 29) and psoriasis (n = 29) were the most targeted indications by DHIs. Most studies analysed diagnostic performance (n = 166), fewer studies analysed acceptance (n = 92) and effectiveness (n = 98). Usability (n = 32) and efficiency (n = 36) were investigated only to a small extent. Studies on DHIs in dermatology have focused on teledermatology and AI applications, with an emphasis on skin cancer diagnosis. Apart from that, a range of DHIs for different user groups, purposes and indications were identified, demonstrating the broad potential for DHIs in dermatology. Further research with a wider set of outcome parameters is needed to fully understand the potential of DHIs and ensure their sustainable implementation into dermatological care.
Collapse
Affiliation(s)
- Patrick Reinders
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anastasia Fleyder
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
4
|
Muthiah S, Craig FE, Sinclair S, Wylie G, Torley D, Wong TH, Morton CA. Rapid Expansion of a Teledermatology Web Application for Digital Dermatology Assessment Necessitated by the COVID-19 Pandemic: Retrospective Evaluation. JMIR Dermatol 2023; 6:e36307. [PMID: 37632929 PMCID: PMC10413227 DOI: 10.2196/36307] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/10/2022] [Revised: 09/27/2022] [Accepted: 05/03/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated a change in the provision of outpatient care in dermatology. OBJECTIVE A novel, asynchronous, digital consultation platform was codeveloped with 2 National Health Service dermatology teams to improve access and enhance choice in outpatient care. METHODS The rollout of the platform was accelerated during the initial COVID-19 lockdown, and its wider use across 2 Scottish health boards was retrospectively evaluated. Integrated with the hospital booking system and electronic patient record, the platform provides an alternative to face-to-face consultations, using information and images submitted by the patients. RESULTS In total, 297 new patient consultations and 108 return patient consultations were assessed, and 80% (324/405) of the images submitted were of satisfactory quality. The consultations were, on average, 3 minutes shorter than equivalent face-to-face interactions, and a total of 5758 km of patient travel was avoided. Outcomes included web-based reviews (66/405, 16.3%), face-to-face reviews (190/405, 46.9%), biopsies (46/405, 11.4%), discharge (89/405, 22%), and other treatments or investigations (14/405, 3.5%). High levels of patient satisfaction (92/112, 82.1%) were reported. CONCLUSIONS Digital dermatology assessments are now included in the choices for consultation types that are available to patients, helping to augment service capacity during pandemic recovery.
Collapse
Affiliation(s)
| | - Fiona E Craig
- Stirling Community Hospital, Stirling, United Kingdom
| | | | - Grant Wylie
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Donna Torley
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | | |
Collapse
|
5
|
Dietrich E, Bara C, Chassain K, Scard C, Beneton N, Maillard H. Overview of dermatologic tele-expertise in areas of low physician density: A retrospective study at Le Mans general hospital. Ann Dermatol Venereol 2023:S0151-9638(23)00027-3. [PMID: 37270319 DOI: 10.1016/j.annder.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/08/2022] [Revised: 12/28/2022] [Accepted: 02/21/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND In areas of low physician density, especially as regards dermatologists in France, there is an increasing interest in tele-expertise. This is particularly the case in the Sarthe department, where the number of physicians continues to decline and access to care was further limited by the COVID 19 epidemic. STUDY DESIGN We retrospectively collected data from tele-expertise requests submitted to Le Mans General Hospital by general practitioners via a dedicated platform between May 6, 2019, and April 9, 2021. RESULTS Six hundred and forty three requests relating to 90 different diagnoses were recorded during this period. One hundred and thirty four patients (20% of requests) were invited to attend a face-to-face consultation within an average of 29 days. DISCUSSION Through the use of tele-expertise at Le Mans Genreal Hospital it was possible to introduce a means of tackling the problem of the lack of dermatologists in the Sarthe department. Rapid responses enabled the number of consultation requests to be reduced, leading to fewer population displacements in the context of the present pandemic. CONCLUSION These initial results are encouraging and confirm that tele-expertise seems a satisfactory option to optimize access to care for populations in areas of low physician density.
Collapse
Affiliation(s)
- E Dietrich
- Service de Dermatologie, Centre Hospitalier, Le Mans, France.
| | - C Bara
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
| | - K Chassain
- Service de Dermatologie, Centre Hospitalier, Lorient, France
| | - C Scard
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
| | - N Beneton
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
| | - H Maillard
- Service de Dermatologie, Centre Hospitalier, Le Mans, France
| |
Collapse
|
6
|
Sondermann W, Wies C, Esser S, Utikal JS, Schadendorf D, Brinker TJ. The “Intimarzt” (intimate doctor) model project: anonymous remote diagnosis of sexually transmitted diseases. Deutsches Ärzteblatt international 2023; 120:94-95. [PMID: 37042644 PMCID: PMC10114138 DOI: 10.3238/arztebl.m2022.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/13/2022] [Accepted: 10/04/2022] [Indexed: 02/03/2023]
|
7
|
Sondermann W. Entwicklungen und Perspektiven der Teledermatologie in Deutschland. J Dtsch Dermatol Ges 2023; 21:101-102. [PMID: 36808458 DOI: 10.1111/ddg.15016_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
|
8
|
Jusuf NK, Putra IB, Puteri Rangkuti AD. Assessing Acne Severity: Teledermatology Versus Face to Face Consultations During the COVID-19 Pandemic. J Clin Aesthet Dermatol 2023; 16:30-34. [PMID: 36743968 PMCID: PMC9891209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Acne vulgaris is a common skin disorder in pilosebaceous units that is self-limited, especially in adolescents. This disease not only causes permanent physical complications but also psychosocial effects that harm the quality of life. Telemedicine has grown its popularity in recent years, especially during the COVID-19 pandemic. Store and Forward (SAF) teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability, and clinical outcomes similar to face-to-face visits. OBJECTIVE We sought to compare the severity of acne vulgaris by teledermatology with face-to-face consultations. We also observe the capability of teledermatology in establishing the severity of acne vulgaris. METHODS This study is an observational analytic study with a cross-sectional design involving 105 patients with a diagnosis of acne vulgaris based on inclusion and exclusion criteria. The characteristics of age and sex were recorded. The severity of acne vulgaris was established directly by the resident and teledermatologically by the dermatologist consultant. Teledermatology was carried out based on photo documentation of five facial lesion areas; namely forehead, chin, right cheek, left cheek, and the entire face, along with photos from the history submitted by the resident. An assessment for acne vulgaris severity was carried out based on the classification from the International Consensus Conference on Acne Classification System. This classification divided acne vulgaris as mild, moderate, and severe with an ordinal measuring scale. A compatibility test was also performed to determine the comparison between teledermatology and face-to-face consultations in establishing the severity of acne vulgaris. Comparison of the severity of acne vulgaris was assessed by the kappa value. RESULTS Acne vulgaris was found more common in women (n=71, 67.6%) and those aged 18 to 22 years (n=55, 52.4%). Most of the subjects have moderate severity based on face-to-face consultations and teledermatology examination (n=52 (49.5%) and n=50 (47.6%), respectively). The value of the capability test between teledermatology and face-to-face consultations in comparing the severity of acne vulgaris is 0.611, which means the capability is considered good. CONCLUSION In this study, the teledermatology examination shows good conformity when compared with face-to-face consultations in assessing severity of acne vulgaris.
Collapse
Affiliation(s)
- Nelva Karmila Jusuf
- All authors are with the Department of Dermatology and Venereology, Faculty of Medicine, at Universitas Sumatera Utara, Universitas Sumatera Utara Hospital in Medan, Indonesia
| | - Imam Budi Putra
- All authors are with the Department of Dermatology and Venereology, Faculty of Medicine, at Universitas Sumatera Utara, Universitas Sumatera Utara Hospital in Medan, Indonesia
| | - Anggita Dwi Puteri Rangkuti
- All authors are with the Department of Dermatology and Venereology, Faculty of Medicine, at Universitas Sumatera Utara, Universitas Sumatera Utara Hospital in Medan, Indonesia
| |
Collapse
|
9
|
Benedit V, Aycock MM. Using teledermatology to prevent and diagnose skin cancer in the rural United States. JAAPA 2022; 35:51-54. [PMID: 36412941 DOI: 10.1097/01.jaa.0000892724.20506.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT In the United States, skin cancer is a prevalent and sometimes preventable form of cancer that causes a significant disease burden in rural and urban communities. Studies have shown, however, that rural residents are less likely to engage in primary prevention behaviors against skin cancer, and rural populations have higher skin cancer incidence and mortality than urban residents. Teledermatology can be used to address disparities in both skin cancer diagnosis and health education to improve dermatology outcomes in rural communities. This article reviews teledermatology formats, barriers, and benefits to encourage integration of teledermatology modalities into clinical practice.
Collapse
Affiliation(s)
- Veronica Benedit
- Veronica Benedit practices in acute care at Piedmont Healthcare in Georgia. Mallory M. Aycock is an adjunct clinical assistant professor in the PA program at Mercer University in Atlanta, Ga. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | |
Collapse
|
10
|
Abstract
Purpose of Review Inpatient teledermatology is a rapidly growing field with significant potential to add value and streamline patient care. This review summarizes the current literature on inpatient teledermatology, primarily focusing on its diagnostic and clinical management utility as compared to live dermatologic evaluation. Recent Findings The COVID-19 pandemic has accelerated the adoption of inpatient teledermatology, which has been shown to be comparable to live hospitalist evaluation for triage, diagnosis, and management of hospitalized patients for a wide variety of conditions. Despite its comparative cost-effectiveness and recent changes in reimbursement practices, inpatient teledermatology still lacks sufficient reimbursement incentive for widespread implementation. Summary Inpatient teledermatology is an effective, efficient, accurate, and cost-effective means of managing the hospital burden of skin disease, especially in areas where access to dermatologic care is limited. It is essential that dermatologists and referring providers comprehend the use and potential pitfalls of inpatient teledermatology to effectively incorporate it into hospital practice.
Collapse
|
11
|
Paudel V. Patterns and Barriers of Teledermatology in Resource Limited Settings in COVID-19 Pandemic: A Descriptive Cross-sectional Survey of Nepalese Dermatologists. JAAD Int 2022; 7:62-66. [PMID: 35281323 PMCID: PMC8901366 DOI: 10.1016/j.jdin.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Objective Methods Results Limitations Conclusion
Collapse
|
12
|
Jobbágy A, Kiss N, Meznerics FA, Farkas K, Plázár D, Bozsányi S, Fésűs L, Bartha Á, Szabó E, Lőrincz K, Sárdy M, Wikonkál NM, Szoldán P, Bánvölgyi A. Emergency Use and Efficacy of an Asynchronous Teledermatology System as a Novel Tool for Early Diagnosis of Skin Cancer during the First Wave of COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19. [PMID: 35270391 DOI: 10.3390/ijerph19052699] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022]
Abstract
Background: After the outbreak of the corona virus disease-19 (COVID-19) pandemic, teledermatology was implemented in the Hungarian public healthcare system for the first time. Our objective was to assess aggregated diagnostic agreements and to determine the effectiveness of an asynchronous teledermatology system for skin cancer screening. Methods: This retrospective single-center study included cases submitted for teledermatology consultation during the first wave of the COVID-19 pandemic. Follow-up of the patients was performed to collect the results of any subsequent personal examination. Results: 749 patients with 779 lesions were involved. 15 malignant melanomas (9.9%), 78 basal cell carcinomas (51.3%), 21 squamous cell carcinomas (13.8%), 7 other malignancies (4.6%) and 31 actinic keratoses (20.4%) were confirmed. 87 malignancies were diagnosed in the high-urgency group (42.2%), 49 malignancies in the moderate-urgency group (21.6%) and 16 malignancies in the low-urgency group (4.6%) (p < 0.0001). Agreement of malignancies was substantial for primary (86.3%; κ = 0.647) and aggregated diagnoses (85.3%; κ = 0.644). Agreement of total lesions was also substantial for primary (81.2%; κ = 0.769) and aggregated diagnoses (87.9%; κ = 0.754). Conclusions: Our findings showed that asynchronous teledermatology using a mobile phone application served as an accurate skin cancer screening system during the first wave of the COVID-19 pandemic.
Collapse
|
13
|
Nikolakis G, Baroud S, Georgopoulos I, Appel L, Zouboulis CC. Teledermatologie: Fluch oder Segen? Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1645-9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungTeledermatologische Dienste haben sich insbesondere während der COVID-19-Pandemie als Alternative zu „Echt“visiten verbreitet. Der Mangel an Dermatologen und die Möglichkeit einer präzisen Diagnose auch bei unterversorgten Regionen macht diese Alternative für alle Beteiligten besonders attraktiv. Trotzdem ist der Bedarf an Schulungen des Personals und der Anwender hoch. Ebenfalls können Implementierungs-, Instandhaltungs- und Wartungskosten der notwendigen Ausrüstung und die Heterogenität der unterschiedlichen Anbieter nachteilig für Patient und Arzt sein. In diesem Artikel werden wesentliche Vorteile und Nachteile der Teledermatologie zusammengefasst.
Collapse
Affiliation(s)
- Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
| | - Sumer Baroud
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
- Sharjah Universität, Sharjah, Vereinigte Arabische Emirate
| | - Ioannis Georgopoulos
- Klinik für Chirurgie, Allgemeines Pädiatrisches Krankenhaus Agia Sofia, Athen, Griechenland
- DOCANDU LTD, London, Vereinigtes Königreich
| | - Lena Appel
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
- Medizinisches Versorgungszentrum des Städtischen Klinikums Dessau, Dessau, Deutschland
| | - Christos C. Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
| |
Collapse
|
14
|
Chow A, Teo SH, Kong JW, Lee S, Heng YK, van Steensel M, Smith H. Patients' Experiences of Telemedicine for Their Skin Problems: Qualitative Study. JMIR Dermatol 2022; 5:e24956. [PMID: 37632855 PMCID: PMC10334905 DOI: 10.2196/24956] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/12/2020] [Revised: 01/20/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Teledermatology is a cost-effective treatment modality for the management of skin disorders. Most evaluations use quantitative data, and far less is understood about the patients' experience. OBJECTIVE This qualitative study aimed to explore patients' perceptions of a teledermatology service linking public primary care clinics to the national specialist dermatology clinic in Singapore. A better understanding of patients' experiences can help refine and develop the care provided. METHODS Semistructured in-depth interviews were conducted with patients who had been referred to the teledermatology service. The interviews were digitally recorded and transcribed before undergoing thematic content analysis. RESULTS A total of 21 patients aged between 22 and 72 years were recruited. The following 3 themes were identified from the data of patients' experiences: positive perceptions of teledermatology, concerns about teledermatology, and ideas for improving the teledermatology service. The patients found the teledermatology service convenient, saving them time and expense and liberating them from the stresses incurred when making an in-person visit to a specialist facility. They valued the confidence and reassurance they gained from having a dermatologist involved in deciding their management. The patients' concern included data security and the quality of the images shared. Nonetheless, they were keen to see the service expanded beyond the polyclinics. Their experiences and perceptions will inform future service refinement and development. CONCLUSIONS This narrative exploration of users' experiences of teledermatology produced rich data enabling a better understanding of the patients' journey, the way they understand and interpret their experiences, and ideas for service refinement. Telemedicine reduces traveling and enables safe distancing, factors that are much needed during pandemics.
Collapse
Affiliation(s)
- Aloysius Chow
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sok Huang Teo
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Jing Wen Kong
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Simon Lee
- National Healthcare Group Polyclinics, Singapore, Singapore
| | | | - Maurice van Steensel
- Skin Research Institute of Singapore, Singapore, Singapore
- Dermatology and Skin Biology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
15
|
Tischler M, Scheidegger EP. Digitale Zukunft als Chance – Teledermatologie-Erfahrungen aus der Praxis. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1671-3353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Hintergrund Verbesserte regulatorische Rahmenbedingungen und die Corona-Pandemie als Katalysator für die Digitalisierung im Gesundheitssystem haben zu einem umfassenden telemedizinischen Angebot geführt. Auf die Dermatologie entfällt dabei ein Drittel der telemedizinischen Leistungen. Die Ausgestaltung der teledermatologischen Leistung variiert dabei je nach Anbieter stark. Die Unterschiede sowie Vor- und Nachteile sind dabei sowohl für Ärztinnen und Ärzte als auch für Patientinnen und Patienten oftmals nicht ersichtlich.
Fragestellung Das Ziel des Beitrags ist daher, einen Überblick zu den Formen und aktuellen Einsatzgebieten der Teledermatologie zu schaffen. Darüber hinaus sollen die Einsatzmöglichkeiten der Anwendungsgebiete in der Teledermatologie eingeordnet werden und anhand von persönlichen Erfahrungen mit einer dermatologischen Telemedizin-Plattform exemplarisch beschrieben werden.
Material und Methode Zur Darstellung der Teledermatologie in Deutschland wurde eine Übersichtsarbeit erstellt, die aktuelle nationale und internationale Studien und Befragungen zum Einsatz der Teledermatologie umfasst. Die exemplarische Vorstellung der asynchronen Teledermatologie am Beispiel des Angebots „OnlineDoctor“ erfolgt anhand von qualitativen Interviews der Autoren mit teilnehmenden Dermatologinnen und Dermatologen sowie öffentlich zugänglichen Produktinformationen.
Ergebnisse In einem Großteil der dermatologischen Fälle ist eine hohe Konkordanz der Diagnose und Patientenzufriedenheit unter Nutzung teledermatologischer Anwendungen erkennbar. Sowohl im Kontext der Diagnosestellung als auch bei der Versorgung chronischer Patientinnen und Patienten und dem Triagieren sind die Vorteile evaluiert. Dabei weisen die verschiedenen teledermatologischen Verfahren insbesondere mit Blick auf die genutzte Technologie (synchron bzw. asynchron) große Unterschiede auf. Die Vorteile der asynchronen Teledermatologie liegen dabei primär in der zeitlichen und örtlichen Flexibilität sowie dem breiten Anwendungsspektrum. Versorgungsdaten aus dem Alltag der beiden Autoren stützen die Aussage, dass Teledermatologie bei gleicher medizinischer Qualität positive Effekte für Patientinnen und Patienten sowie Praxen hat.
Diskussion Die Teledermatologie hat das Potenzial, Prozesse in Praxen zu verbessern und näher an der Patientin und dem Patienten zu arbeiten. Dabei ist unter dem Stichwort „Patient Empowerment“ eine patientenzentrierte Medizin anzustreben und die Möglichkeiten der digitalen Anwendungen sind zu nutzen. Die Autoren gehen davon aus, dass sich in den kommenden Jahren sowohl die Indikationen, die via Telemedizin diagnostiziert werden können, als auch die Einsatzfelder erweitern werden. Die Zukunft wird eine weitere Individualisierung des digitalen Angebotes ermöglichen und die kombinierte Nutzung von digitalen Tools und analogen Untersuchungen in der Praxis zum Goldstandard werden lassen.
Collapse
|
16
|
Abstract
Hintergrund In den letzten Jahren wurden mit dem E‑Health-Gesetz und der Lockerung des Fernbehandlungsverbotes die Rahmenbedingungen für die Telemedizin in Deutschland verbessert. Fragestellung Das Ziel dieses Beitrags ist es, eine Übersicht wichtiger Anwendungsgebiete der Teledermatologie darzustellen. Material und Methode Erstellt wurde eine narrative Übersichtsarbeit von nationalen und internationalen Studien und Projekten zum Einsatz der Teledermatologie für die Diagnosestellung, die Verlaufskontrolle, die Triage zwischen Haus- und Hautärzten sowie den Einsatz in Einrichtungen mit organisatorisch und/oder geografisch erschwertem Zugang zu fachmedizinischer Versorgung. Ergebnisse Diagnostische Anwendungen ermöglichen in einem Großteil der Fälle die teledermatologische Beurteilung bei hoher Konkordanz der Diagnose und Patientenzufriedenheit. In der Versorgung chronischer Patienten wurde in der Mehrzahl von Studien nachgewiesen, dass kein Unterschied in der Effektivität der Behandlung zwischen der Präsenz- und Fernbehandlung vorliegt und Patienten Anfahrtswege und Wartezeiten einsparen. Bei dermatologischen Fällen, die mithilfe der Teletriage evaluiert wurden, konnte ein Großteil beim Hausarzt verbleiben. Gleichzeitig wurden Patienten identifiziert, die schnellstmöglich beim Hautarzt vorstellig werden sollten. In besonderen Einrichtungen wie Justizvollzugsanstalten werden dermatologische Telekonsile erfolgreich eingesetzt. Diskussion Für die Nutzung der Teledermatologie in Deutschland liegen hinreichende Rahmenbedingungen und eine befriedigende Evidenz vor. Die Anwendungsbereiche sind detailliert in der S2k-Leitlinie der Teledermatologie abgebildet. Es besteht das Risiko, dass der Zugang zur Telemedizin für bestimmte Bevölkerungsgruppen erschwert sein könnte.
Collapse
|
17
|
Pokharel S, Poudel S, Agrawal S, Marahatta S. Awareness, acceptability, and satisfaction of teledermatology consultation among social-media users in Nepal. J Cosmet Dermatol 2021; 21:3078-3084. [PMID: 34716752 DOI: 10.1111/jocd.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Teledermatology refers to the use of telecommunication in consulting one's skin problem to a dermatologist at distance. AIMS This study aims to identify the awareness, acceptability, preferred technical tools, willingness to use, comfortability, and satisfaction of teledermatology among social-media users in Nepal. METHODS It was an exploratory cross-sectional study performed on 360 social-media users, subjected to web-based interview based on pretested proforma containing questions to address: awareness of telemedicine, type and tools preferred for teledermatology, willingness to use, comfortability, and satisfaction of teledermatology services. RESULTS Most of the participants (60.8%) were initially unaware of telemedicine. Despite this, the majority (81.9%) were willing to use the services after being aware, mostly during the follow-up (36.6%). Most of the participants (61.1%) preferred the hybrid model for teleconsultation, while mobile was the preferred technical tool (68.1%) mostly because of its compatibility (84.1%) and portability (56.3%). The majority of the participants felt that teledermatology consultation would be beneficial (77.2%) and they mostly preferred it directly from a dermatologist (85.6%). About two-thirds (64.2%) also believed that teledermatology consultation would eliminate the need for a face-to-face consultation. The majority would be comfortable (68.1%) if their skin lesions are photographed and sent to a dermatologist and would be satisfied (62.5%) with the consultations, through Wi-Fi and mobile data both (55.6%), and via Facebook (97.2%) and Viber (70.8%). CONCLUSIONS Despite being unaware of telemedicine, the participants were willing to use teledermatology consultation and thought that they would be comfortable and satisfied with it.
Collapse
Affiliation(s)
| | - Sishir Poudel
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sudha Agrawal
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suchana Marahatta
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
18
|
Abstract
The COVID-19 pandemic has forever changed health care, spurring a revolution in digital health technologies. Across the world, hundreds of thousands of health care systems are considering a central question: how do we connect with our patients? Digital health has been used as a stopgap in many cases to continue the essential functions of health systems. As the post-pandemic world and our "new normal" come into focus, further needs will have to be met with a digital patient interaction, with an eye toward value transformation. One barrier to fully leveraging digital tools is the lack of a framework for classifying the type of digital health care. This can limit our ability to design, deploy, evaluate, and communicate through digital means. This article presents 3 categories of digital health and their relationships to value metrics: (1) telehealth or direct care delivery, (2) digital access tools, and (3) digital monitoring. An evidence-based discussion reveals past successes, current promises, and future challenges in reducing defects in value through digital care. In the coming years, value transformation will become more crucial to the success of health care systems. By using the taxonomy in this article, health systems can better implement digital tools with a value-driven purpose. Defining the role of digital health in the post-pandemic world is needed to assist health systems and practices to build a bridge to value-based care.
Collapse
Affiliation(s)
- Brian D'Anza
- Department of Digital Health/Telehealth, University Hospitals, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Peter J Pronovost
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,University Hospitals, Cleveland, Ohio, USA.,Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.,Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
19
|
Stadler PC, Senner S, Frey S, Clanner-Engelshofen BM, H Frommherz L, French LE, Reinholz M. Teledermatology in times of COVID-19. J Dermatol 2021; 48:620-624. [PMID: 33715181 PMCID: PMC8250059 DOI: 10.1111/1346-8138.15812] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/28/2021] [Indexed: 12/25/2022]
Abstract
Remote consultations are likely to grow in importance in the following years, especially if the coronavirus disease 2019 (COVID‐19) pandemic continues. Patients’ opinions on teledermatology have already been analyzed, but a current analysis during the COVID‐19 pandemic is lacking. The purpose of this survey was to investigate the satisfaction of patients who had received dermatological advice via telephone during the COVID‐19 pandemic and to analyze their general opinion about eHealth as well as possible limitations for a broad implementation. Ninety‐one patients managed in the dermatology department using telephone consultation during the COVID‐19 pandemic were interviewed. An anonymous questionnaire, including the established quality of life questionnaire (Dermatology Life Quality Index [DLQI]), was used. It was found that men were more satisfied with telephone consultations than women (p = 0.029), educational level and age did not correlate with satisfaction (p = 0.186 and 388, respectively), and the longer the waiting time for a telephone consultation, the lower the satisfaction (p = 0.001). Grouped analysis of all participants showed that the majority (54.0% n = 38/71) were “very happy” with the telephone consultation. Higher disease burden (DLQI) was associated with lower satisfaction (p = 0.042). The main stated reasons for using telemedicine were shorter waiting times (51.6% n = 47/91) and no travel requirement (57.1% n = 47/91). Almost one‐quarter (23.1% n = 21/89) of patients would use teledermatology in the future, 17.6% (n = 16/89) would not, and 57.1% (n = 51/89) would only use it in addition to a traditional consultation with personal contact. In conclusion, most patients in the study group still preferred traditional face‐to‐face medical consultations to telephone consultations, but also desired an add‐on telemedical tool. Dermatological care using more modern telemedicine technologies than telephone conferencing is needed to better address patients’ desires, especially in times of the COVID‐19 pandemic.
Collapse
Affiliation(s)
- Pia-Charlotte Stadler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Sonja Senner
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Surina Frey
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | | | - Leonie H Frommherz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.,Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
| | - Markus Reinholz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
20
|
Lee MS, Stavert R. Factors Contributing to Diagnostic Discordance Between Store-and-Forward Teledermatology Consultations and In-Person Visits: Case Series. JMIR Dermatol 2021; 4:e24820. [PMID: 37632800 PMCID: PMC10501508 DOI: 10.2196/24820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Use of asynchronous store-and-forward (SAF) teledermatology can improve access to timely and cost-effective dermatologic care and has increased during the COVID-19 pandemic. Previous research has found high diagnostic concordance rates between SAF teledermatology and face-to-face clinical diagnosis, but to our knowledge, none have used specific cases to illustrate factors contributing to diagnostic discordance. OBJECTIVE To identify and illustrate characteristics that may have contributed to diagnostic discordance between store-and-forward teledermatology and in-person clinical diagnosis in a series of patients. METHODS We identified 7 cases of diagnostic discordance between teledermatology and in-person visits where the favored diagnosis of the in-person dermatologist was not included in the differential diagnosis formulated by the teledermatologist. Cases were identified from a previously published retrospective chart review of 340 SAF teledermatology consultations, which was previously performed at an academic community health care system in the greater Boston area, Massachusetts, from January 1, 2014, through December 31, 2017. Of 99 patients who completed an in-person dermatology appointment after their teledermatology consultation, 7 had diagnostic disagreement between the teledermatologist and in-person dermatologist where the diagnosis in the in-person consultation was not included in the differential diagnosis in the original teledermatology consult. These 7 cases were examined by 2 author reviewers to identify factors that may have contributed to diagnostic discordance. RESULTS Factors contributing to diagnostic discordance between SAF teledermatology consultations and in-person visits included poor image quality, inadequate history or diagnostic workup, inability to evaluate textural characteristics, diagnostic uncertainty due to atypical presentations, and evolution in appearance of skin conditions over time. CONCLUSIONS We identified multiple factors that contributed to diagnostic discordance. Recognition and mitigation of these factors, when possible, may help to improve diagnostic accuracy and reduce the likelihood of misdiagnosis. Continuing education of referring providers and implementation of standardized guidelines for referrals may also be helpful in reducing the risk of misdiagnosis due to inherent limitations of teledermatology services.
Collapse
Affiliation(s)
| | - Robert Stavert
- Department of Dermatology, Cambridge Health Alliance, Somerville, MA, United States
| |
Collapse
|
21
|
Johnsen TM, Norberg BL, Kristiansen E, Zanaboni P, Austad B, Krogh FH, Getz L. Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners. J Med Internet Res 2021; 23:e26433. [PMID: 33465037 PMCID: PMC7872327 DOI: 10.2196/26433] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. Objective This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. Methods A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. Results In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. Conclusions Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.
Collapse
Affiliation(s)
- Tor Magne Johnsen
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Børge Lønnebakke Norberg
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Paolo Zanaboni
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Helgetun Krogh
- Norwegian Centre for E-health Research, Tromsø, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Linn Getz
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
22
|
Perdoncini NN, Schussel JL, Amenábar JM, Torres-Pereira CC. Use of smartphone video calls in the diagnosis of oral lesions: Teleconsultations between a specialist and patients assisted by a general dentist. J Am Dent Assoc 2021; 152:127-135. [PMID: 33494867 DOI: 10.1016/j.adaj.2020.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Teleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine. METHODS Patients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient. RESULTS Thirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922). CONCLUSIONS Synchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions. PRACTICAL IMPLICATIONS Earlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions.
Collapse
|
23
|
Abstract
Dermatology is a clinical and visual discipline, which makes it the quintessential medical specialty for spot diagnosis and telemedicine. The COVID-19 pandemic has led to an unprecedented worldwide renaissance of teledermatology (TD). It has helped deliver high-quality medical care, while protecting the medical personnel and vulnerable patients from potential infection. Examining a patient from a distance through digital photography has many drawbacks, including lack of physical touch, difficulties in performing full body examinations, and several legal and ethical issues. We summarize have summarized the more common pitfalls and highlight the key aspects of direct patient-to-physician TD. Basic practical advice includes the use of TD for obtaining patient history, examining patient-captured photographs for inflammatory skin disease, and skin cancer screening.
Collapse
Affiliation(s)
- Karen Manuelyan
- Department of Dermatology and Venereology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria; Department of Dermatology, Luton & Dunstable University Hospital, Luton, United Kingdom.
| | - Martin Shahid
- Department of Dermatology and Venereology, Medical Faculty, Medical University, Sofia, Bulgaria
| | - Vassil Vassilev
- Department of Urology, Medical Faculty, Medical University, Sofia, Bulgaria
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical Faculty, Medical University, Sofia, Bulgaria
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical Faculty, Medical University, Sofia, Bulgaria
| |
Collapse
|
24
|
Sondermann W, von Kalle C, Utikal JS, Schadendorf D, Esser S, Durani B, Durani H, Jansen M, Brinker TJ. [External scientific evaluation of the first teledermatology app without direct patient contact in Germany (Online Dermatologist-AppDoc)]. Hautarzt 2020; 71:887-97. [PMID: 32728813 DOI: 10.1007/s00105-020-04660-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Teledermatology addresses the problems associated with the lack of specialists and the often long waiting time for an appointment with a dermatologist. The research project Online Dermatologist-AppDoc enables a fast anonymous expert opinion and was approved on 22 October 2018 by the Landesärztekammer Baden-Württemberg for 2 years as a model project. OBJECTIVES The aim of the present work is the presentation of the first real healthcare data for German teledematology within the framework of the external quality assurance of the model project Online Dermatologist-AppDoc. MATERIALS AND METHODS Anonymous data records submitted to Online Dermatologist-AppDoc between 21 November 2018 and 1 August 2019 were analyzed qualitatively and quantitatively at the Department of Dermatology of the University Hospital Essen. In addition to the evaluation of the data records submitted so far, 100 cases submitted underwent a second assessment by a board-certified dermatologist to assess concordance. RESULTS A total of 1364 cases (60.4% men, 39.6% women) were included in the current first external scientific evaluation. In 90.3% of the cases, remote diagnosis was possible. The two most frequent diagnoses were different forms of eczema (n = 270) and nevi (n = 163). Almost two thirds of the patients (64.3%) could be treated teledermatologically only. The random second examination of 100 cases resulted in an agreement of the diagnosis including the differential diagnosis/diagnoses in 97% of the cases. CONCLUSIONS The first external scientific evaluation of the teledermatological model project Online Dermatologist-AppDoc indicates that the reduction of spatial and temporal barriers of a dermatological examination as well as the teledermatological triage have been so far successful.
Collapse
|
25
|
Kazi R, Evankovich MR, Liu R, Liu A, Moorhead A, Ferris LK, Falo LD, English JC. Utilization of Asynchronous and Synchronous Teledermatology in a Large Health Care System During the COVID-19 Pandemic. Telemed J E Health 2020; 27:771-777. [PMID: 33074786 DOI: 10.1089/tmj.2020.0299] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Teledermatology offers an opportunity to continually deliver care during the coronavirus disease 2019 pandemic. Objective: To provide quantitative data about the use of teledermatology. Methods: Retrospective analysis of teledermatology consultations was performed from March 16 to May 1, 2020. The number/type of encounters, differences in diagnoses, and prescriptions between asynchronous and synchronous teledermatology visits were analyzed. Results: A total of 951 visits (36.2%) were asynchronous whereas 1,672 visits (63.8%) were synchronous. Only 131 (<5%) visits required an acute in-person follow-up. The diagnosis of acne was more frequent with asynchronous visits (p < 0.002, Bonferroni corrected). Antibiotics and nonretinoid acne medications were prescribed more with asynchronous visits, whereas immunomodulators and biologics were more commonly prescribed with synchronous visits (p < 0.02, Bonferroni corrected). Providers at our institution were split on preferred mode (54.2% synchronous, 45.8% asynchronous); however, synchronous visits were preferred for complex medical dermatology patients and return patients (p < 0.05). Limitations: This study is limited by being a single-center study. Conclusions: Asynchronous teledermatology was used more for acne management, whereas synchronous teledermatology was preferable to providers for complex medical dermatology. Postanalysis of the data collected led us to institute a hybridization of our asynchronous and synchronous teledermatology.
Collapse
Affiliation(s)
- Rashek Kazi
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maria R Evankovich
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca Liu
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew Liu
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Autumn Moorhead
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Louis D Falo
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
26
|
Blum A, Bosch S, Haenssle HA, Fink C, Hofmann-Wellenhof R, Zalaudek I, Kittler H, Tschandl P. [Artificial intelligence and smartphone program applications (Apps) : Relevance for dermatological practice]. Hautarzt 2020; 71:691-698. [PMID: 32720165 DOI: 10.1007/s00105-020-04658-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ADVANTAGES OF ARTIFICIAL INTELLIGENCE (AI) With responsible, safe and successful use of artificial intelligence (AI), possible advantages in the field of dermato-oncology include the following: (1) medical work can focus on skin cancer patients, (2) patients can be more quickly and effectively treated despite the increasing incidence of skin cancer and the decreasing number of actively working dermatologists and (3) users can learn from the AI results. POTENTIAL DISADVANTAGES AND RISKS OF AI USE: (1) Lack of mutual trust can develop due to the decreased patient-physician contact, (2) additional time effort will be necessary to promptly evaluate the AI-classified benign lesions, (3) lack of adequate medical experience to recognize misclassified AI decisions and (4) recontacting a patient in due time in the case of incorrect AI classifications. Still problematic in the use of AI are the medicolegal situation and remuneration. Apps using AI currently cannot provide sufficient assistance based on clinical images of skin cancer. REQUIREMENTS AND POSSIBLE USE OF SMARTPHONE PROGRAM APPLICATIONS Smartphone program applications (apps) can be implemented responsibly when the image quality is good, the patient's history can be entered easily, transmission of the image and results are assured and medicolegal aspects as well as remuneration are clarified. Apps can be used for disease-specific information material and can optimize patient care by using teledermatology.
Collapse
Affiliation(s)
- A Blum
- Hautarzt- und Lehrpraxis, Augustinerplatz 7, 78462, Konstanz, Deutschland.
| | - S Bosch
- Hautarztpraxis, Ludwigsburg, Deutschland
| | - H A Haenssle
- Universitäts-Hautklinik Heidelberg, Heidelberg, Deutschland
| | - C Fink
- Universitäts-Hautklinik Heidelberg, Heidelberg, Deutschland
| | - R Hofmann-Wellenhof
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Graz, Österreich
| | - I Zalaudek
- Dermatology Clinic, University Hospital of Trieste, Hospital Maggiore, Trieste, Italien
| | - H Kittler
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - P Tschandl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| |
Collapse
|
27
|
Miller BJ, Finnane A, Vun Y, Halloran S, Stapelberg A, Soyer HP, Caffery L. Real-time teledermatology clinics in a tertiary public hospital: A clinical audit. Australas J Dermatol 2020; 61:e383-e387. [PMID: 32392628 DOI: 10.1111/ajd.13322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/01/2019] [Revised: 03/22/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Our metropolitan hospital provides a real-time videoconference teledermatology clinic to enable patients in rural and remote Queensland to access a specialist for dermatology care. METHODS Retrospective clinical audit of all patient referrals to the videoconference teledermatology clinic for a two-year period. RESULTS A total of 483 consultations for 178 patients were conducted by the teledermatology clinic. Most patients were from remote and very remote regions of Queensland with a mean distance from our metropolitan hospital to the patient's town of residence of 1295 km. The most common reason for referral, as per the referral form, was rash (32%), followed by acne (12%) and dermatitis (11%). Most (78%) referrals came from general practitioners. Around 8% of patients seen in the teledermatology clinic were converted to in-person review; 81% of patients were managed via teledermatology, and 10% of patients did not attend the scheduled teleconsultation. CONCLUSION The outpatient teledermatology clinic run through the Telehealth Centre of a metropolitan hospital is an effective way of delivering a general dermatology consultation service to rural and remote patients in a timely manner.
Collapse
Affiliation(s)
- Bradley J Miller
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Anna Finnane
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Yin Vun
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sean Halloran
- Centre for Online Health, Princess Alexandra Hospital Telehealth Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Anesce Stapelberg
- Centre for Online Health, Princess Alexandra Hospital Telehealth Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Liam Caffery
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Centre for Online Health, Centre for Health Services Research, Brisbane, Queensland, Australia
| |
Collapse
|
28
|
Abstract
Rashes, ulcers and skin lesions are well suited for telemedicine. We have developed a smartphone app, the first of its kind in Norway, where a referring physician can write a short medical history and take clinical and dermatoscopic photographs with a smartphone, which is then sent to and evaluated by a dermatologist. In the period from June 1st, 2017, to September 1st, 2019, clinical information and photographs of rash and skin lesions from 171 patients were sent by 40 primary care and nursing home physicians via the smartphone app to four dermatologists for diagnosis and therapeutic advice. A wide range of dermatological conditions were diagnosed, most commonly chronic ulcers (17%), eczema (15%) and pigmented lesions (13%). Assessed later by a dermatologist, referral for regular consultations with a specialist was avoided in 119 patients (70%). Sixteen patients (9%) were recommended a regular consultation with a dermatologist; information for prioritization in the specialist healthcare service was then provided. In 36 patients (21%), further measures by the referring physician were recommended. Our experience indicates that many ordinary consultations on rash, ulcers and skin lesions in the specialist healthcare services can be avoided when using the smartphone app.
Collapse
Affiliation(s)
| | - Thomas Schopf
- National Centre for e-Health Research, University Hospital Northern Norway, Tromsø, Norway
| | | | | | - Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
29
|
|
30
|
Kho J, Gillespie N, Horsham C, Snoswell C, Vagenas D, Soyer HP, Janda M. Skin Doctor Consultations Using Mobile Teledermoscopy: Exploring Virtual Care Business Models. Telemed J E Health 2020; 26:1406-1413. [PMID: 32058835 DOI: 10.1089/tmj.2019.0228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Technological advances have given rise to virtual health care services, resulting in a shift in how traditional health care services are being delivered. Consumers are increasingly demanding efficient access to health care information and services irrespective of time and distance, which is further driving the digitization of health care. This digital economy has created new opportunities for innovative new business models to meet the needs of these new markets. This study explores several in-use business models of virtual health care service platforms that incorporate mobile teledermoscopy (MTD) technologies. By comparing the different building blocks of these commercial ventures, we provide insights on business model choices and discuss the elements that contribute to economically sustainable and viable service offerings incorporating MTD applications. Materials and Methods: We searched the literature on teledermatology, complemented by searches using Google and other mobile app store platforms, and identified seven commercial ventures using teledermoscopy. We analyzed the building blocks of each business model by using an adapted version of Ash Maurya's Lean Canvas and Alexander Osterwalder's Business Model Canvas. Results: We identified three business elements that support the viability, sustainability, and growth of online dermatology services: developing key partnerships, clinician involvement in the design and implementation process, and managing the medico-legal risks and liabilities that are relevant for each country. Conclusions: Leveraging mobile technologies to deliver virtual health care present new business opportunities for health care providers. A better understanding of the business features associated with existing commercial ventures may increase uptake and improve financial viability of MTD applications as a complementary tool to traditional patient care models.
Collapse
Affiliation(s)
- Joanna Kho
- UQ Business School, The University of Queensland, St Lucia, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, St Lucia, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Centaine Snoswell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| |
Collapse
|