Colleen K Gabel1, Emily Nguyen1, Ryan Karmouta2, Kristina J Liu3, Guohai Zhou4, Allireza Alloo5, Ryan Arakaki6, Yevgeniy Balagula7, Alina G Bridges8, Edward W Cowen9, Mark Denis P Davis8, Alisa Femia10, Joanna Harp11, Benjamin Kaffenberger12, Jesse J Keller13, Bernice Y Kwong14, Alina Markova15, Melissa Mauskar16, Robert Micheletti17, Arash Mostaghimi4, Joseph Pierson18, Misha Rosenbach17, Zachary Schwager19, Lucia Seminario-Vidal20, Victoria R Sharon5, Philip I Song21, Lindsay C Strowd22, Andrew C Walls4, Karolyn A Wanat23, David A Wetter8, Scott Worswick24, Carolyn Ziemer25, Joseph Kvedar1, Anar Mikailov26, Daniela Kroshinsky27. 1. Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. 2. Division of Dermatology, University of California-Los Angeles, Los Angeles, California. 3. Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts. 4. Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts. 5. Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. 6. Department of Dermatology, University of California-San Francisco, San Francisco, California. 7. Department of Medicine, Division of Dermatology, Montefiore Medical Center, Bronx, New York. 8. Department of Dermatology, Mayo Clinic, Rochester, Minnesota. 9. Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland. 10. Department of Dermatology, New York University School of Medicine, New York, New York. 11. Department of Dermatology, Weill Cornell Medicine, New York, New York. 12. Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio. 13. Department of Dermatology, Oregon Health & Science University, Portland, Oregon. 14. Department of Dermatology, Stanford University School of Medicine, Stanford, California. 15. Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York. 16. Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. 17. Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. 18. Dermatology Division, University of Vermont Medical Center, Burlington, Vermont. 19. Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts. 20. Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida. 21. Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, California. 22. Department of Dermatology, Wake Forest Baptist Health, Winston-Salem, North Carolina. 23. Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin. 24. Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, California. 25. Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina. 26. Department of Dermatology, Beth Israel Lahey Health, Burlington, Massachusetts. 27. Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dkroshinsky@partners.org.
Abstract
BACKGROUND: Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data. METHODS: This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic. RESULTS: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone. LIMITATIONS: Selection bias and single-center nature. CONCLUSIONS: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
BACKGROUND: Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data. METHODS: This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic. RESULTS: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone. LIMITATIONS: Selection bias and single-center nature. CONCLUSIONS: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
Authors: Matthew F Helm; Alexa B Kimball; Melissa Butt; Heather Stuckey; Heather Costigan; Kanade Shinkai; Arielle R Nagler Journal: Int J Womens Dermatol Date: 2022-03-25