title: Teledermatology's impact on time to intervention among referrals to a dermatology consult service.
abstract: The aim of this study was to determine if a teledermatology consult system, using store-and-forward digital imaging technology, results in patients achieving a shorter time from referral date to date of initial definitive intervention when compared to a traditional referral process. Patients being referred to the dermatology consult service from the primary care clinics at the Durham VA Medical Center were randomized to either a teledermatology consultation or usual care. A usual care consultation consisted of a text-based electronic consult request. A teledermatology consultation included digital images and a standardized history, in addition to the text-based electronic consult. Time to initial definitive intervention was defined as the time between referral date and the date the patient was scheduled for a clinic visit for those patients that the consultant requested a clinic-based evaluation, or the time between referral date and the date the consult was answered by the consultant if a clinic visit was not required. Patients in the teledermatology arm of the study reached a time to initial definitive intervention significantly sooner than did those patients randomized to usual care (median 41 days versus 127 days, p = 0.0001, log-rank test). Additionally, 18.5% of patients in the teledermatology arm avoided the need for a dermatology clinic-based visit compared to zero patients avoiding a dermatology clinic visit in the usual care arm of the study (p < 0.001, z-test). Teledermatology consult systems can result in significantly shorter times to initial definitive intervention for patients compared to traditional consult modalities, and, in some cases, the need for a clinic-based visit can be avoided.
authors.affiliation: Institute for Clinical and Epidemiologic Research, VA Medical Center, Durham, North Carolina, USA. white046@mc.duke.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Whited
authors.forename: Russell P
authors.initials: RP
authors.lastname: Hall
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Foy
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Marbrey
authors.forename: Steven C
authors.initials: SC
authors.lastname: Grambow
authors.forename: Tara K
authors.initials: TK
authors.lastname: Dudley
authors.forename: Santanu
authors.initials: S
authors.lastname: Datta
authors.forename: David L
authors.initials: DL
authors.lastname: Simel
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003880:Dermatology / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009657:North Carolina; D010044:Outpatient Clinics, Hospital; D011320:Primary Health Care; D012017:Referral and Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data; D019114:Remote Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data; D013997:Time Factors; D013996:Time and Motion Studies