title: Reliability and accuracy of dermatologists' clinic-based and digital image consultations.
abstract: BACKGROUND
  Telemedicine technology holds great promise for dermatologic health care delivery. However, the clinical outcomes of digital image consultations (teledermatology) must be compared with traditional clinic-based consultations.
  
  
  OBJECTIVE
  Our purpose was to assess and compare the reliability and accuracy of dermatologists' diagnoses and management recommendations for clinic-based and digital image consultations.
  
  
  METHODS
  One hundred sixty-eight lesions found among 129 patients were independently examined by 2 clinic-based dermatologists and 3 different digital image dermatologist consultants. The reliability and accuracy of the examiners' diagnoses and the reliability of their management recommendations were compared.
  
  
  RESULTS
  Proportion agreement among clinic-based examiners for their single most likely diagnosis was 0. 54 (95% confidence interval [CI], 0.46-0.61) and was 0.92 (95% CI, 0. 88-0.96) when ratings included differential diagnoses. Digital image consultants provided diagnoses that were comparably reliable to the clinic-based examiners. Agreement on management recommendations was variable. Digital image and clinic-based consultants displayed similar diagnostic accuracy.
  
  
  CONCLUSIONS
  Digital image consultations result in reliable and accurate diagnostic outcomes when compared with traditional clinic-based consultations.
authors.affiliation: Institute for Clinical and Epidemiologic Research, Veterans Affairs (VA) Medical Center, Durham, North Carolina 27705, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Whited
authors.forename: R P
authors.initials: RP
authors.lastname: Hall
authors.forename: D L
authors.initials: DL
authors.lastname: Simel
authors.forename: M E
authors.initials: ME
authors.lastname: Foy
authors.forename: K M
authors.initials: KM
authors.lastname: Stechuchak
authors.forename: R J
authors.initials: RJ
authors.lastname: Drugge
authors.forename: J M
authors.initials: JM
authors.lastname: Grichnik
authors.forename: S A
authors.initials: SA
authors.lastname: Myers
authors.forename: R D
authors.initials: RD
authors.lastname: Horner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019114:Remote Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012871:Skin Diseases / Q000175:diagnosis*