Sangeeta S Marwaha1, Helene Fevrier2, Stacey Alexeeff2, Eileen Crowley3, Michael Haiman4, Ngoc Pham5, Melanie J Tuerk6, Danny Wukda7, Michael Hartmann7, Lisa J Herrinton8. 1. Dermatology, Kaiser Permanente, Sacramento, California. 2. Division of Research, Kaiser Permanente, Oakland, California. 3. Dermatology, Kaiser Permanente, Vallejo, California. 4. Dermatology, Kaiser Permanente, Santa Rosa, California. 5. Dermatology, Kaiser Permanente, Santa Clara, California. 6. Dermatology, Kaiser Permanente, Walnut Creek, California. 7. The Permanente Medical Group, Quality and Operations Support, Kaiser Permanente, Oakland, California. 8. Division of Research, Kaiser Permanente, Oakland, California. Electronic address: Lisa.Herrinton@kp.org.
Abstract
BACKGROUND: The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood. OBJECTIVE: We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows. METHODS: Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017. RESULTS: One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective. LIMITATIONS: Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias. CONCLUSION: Implementation is critical to the effectiveness of teledermatology.
BACKGROUND: The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood. OBJECTIVE: We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows. METHODS: Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017. RESULTS: One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective. LIMITATIONS: Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias. CONCLUSION: Implementation is critical to the effectiveness of teledermatology.
Authors: Sangeeta Marwaha; Jennifer R Dusendang; Stacey E Alexeeff; Eileen Crowley; Michael Haiman; Ngoc Pham; Melanie J Tuerk; Danny Wudka; Michael Hartmann; Lisa J Herrinton Journal: Perm J Date: 2021-12-13