Study Examines Use of Teledermatology for Inpatient Dermatology Consultations

Teledermatology (remote delivery of dermatology consultations) can help triage patients and make inpatient dermatology consultations at the hospital more efficient, according to a study published by JAMA Dermatology, a JAMA Network publication. 1

Many hospitals do not have inpatient dermatology consultation services. Teledermatology may help dermatologists outside the hospital determine how quickly they need to consult on a hospitalized patient, according to the study background.

John S. Barbieri, B.A., of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues analyzed 50 inpatient dermatology consultations between 2012 and 2013. Participants were evaluated separately by both an in-person dermatologist and two independent teledermatologists. Study outcomes were measured by agreements in initial patient triage decisions and the decision to biopsy.

According to study results, teledermatologists agreed in 90 percent of consultations if the in-person dermatologist recommended the patient be seen the same day, and agreed in 95 percent of cases if the in-person dermatologist recommended a biopsy. Teledermatologists were able to triage 60 percent of consultations to be seen the next day or later and 10 percent of patients to be seen as outpatients after discharge.

“Our study suggests that teledermatology is reliable for the initial triage of inpatient dermatologic consultations at an academic medical center and that it can potentially increase efficiency. We anticipate that future studies that refine the model presented here may find stronger concordance and efficiency gains,” the authors conclude.

In a related commentary2 , Lindy P. Fox, M.D., of the University of California, San Francisco, writes: “Providing effective and consistent inpatient consultations via teledermatology will require standardizing the type of information gathered and presented to the consultant, photography used and method of information delivery. The next step is to validate the assumption that the use of teledermatology in the inpatient setting leads to increased efficiency, improved access, better outcomes, and decreased costs while still delivering quality care. Finally, teleconsultation programs must be made widely available and the work reimbursable for teledermatology to succeed in the inpatient setting.”

“While the value of an in-person dermatologic consultation cannot be overemphasized, teledermatology as a means to increase accessibility to dermatologists and deliver care to hospitalized patients may be an important step toward closing the gap.”

References:

1. JAMA Dermatology. Published online February 12, 2014. doi:10.1001/jamadermatol.2013.9517.

2. JAMA Dermatology. Published online February 12, 2014. doi:10.1001/jamainternmed.2013.9516.