title: The substitution of digital images for dermatologic physical examination.
abstract: OBJECTIVE
  To investigate the diagnostic accuracy of clinicians viewing a patient's history and static digital image set compared with clinicians who conducted office-based physical examinations of the same patients.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  One hundred sixteen adult patients presenting with dermatologic symptoms in a university-based practice who consented to have their skin conditions documented with a still digital camera according to a standardized protocol.
  
  
  METHODS
  Concordance between office-based dermatologists' diagnoses and 2 remote clinicians' diagnoses using still digital images (resolution, 92 dots per inch) and identical medical history data to render diagnoses.
  
  
  RESULTS
  When photographic quality was high and office-based clinician certainty was high, remote clinicians were in agreement more than 75% of the time. Office-based and remote clinicians were in agreement 61% to 64% of the time for all cases. No specific disease category appeared to be more or less amenable to diagnosis based on still digital imagery. The diagnostic certainty of the office-based clinician (reported from 0-10) had the most impact on agreement. When cases with office-based clinician certainty of no more than 7 were compared with cases with certainty of at least 9, agreement increased 54% for remote clinician 1 and 111% for remote clinician 2. As an isolated variable, photographic quality had a modest impact on agreement.
  
  
  CONCLUSIONS
  Still digital images can substitute for the dermatologic physical examination in up to 83% of cases. This study provides validation of the store-and-forward concept of telemedicine as applied to dermatology. These results serve as the foundation for field testing of the concept in primary care settings.
authors.affiliation: Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Kvedar
authors.forename: R A
authors.initials: RA
authors.lastname: Edwards
authors.forename: E R
authors.initials: ER
authors.lastname: Menn
authors.forename: M
authors.initials: M
authors.lastname: Mofid
authors.forename: E
authors.initials: E
authors.lastname: Gonzalez
authors.forename: J
authors.initials: J
authors.lastname: Dover
authors.forename: J A
authors.initials: JA
authors.lastname: Parrish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D010781:Photography; D010808:Physical Examination; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D012871:Skin Diseases / Q000175:diagnosis*