title: Potential effect of patient-assisted teledermatology on outpatient referral rates.
abstract: We carried out a pilot study on the feasibility and accuracy of store-and-forward teledermatology based on patient-provided images and history as a triage tool for outpatient consultation. Patients referred by their general practitioner provided a history and images via the Internet. The information was reviewed by one of 12 teledermatologists and the patient then visited a different dermatologist in person within two days. Three independent dermatologists compared the remote and in-person diagnoses in random order to determine diagnostic agreement. Broader agreement was also measured, by comparing the main disease groups into which the two diagnoses fell. The teledermatologists indicated whether an in-person consultation or further investigations were necessary. There were 105 eligible patients, aged four months to 72 years, who were willing to participate. For the 96 cases included in the analysis, complete diagnostic agreement was found in 41% (n=39), partial diagnostic agreement in 10% (n=10) and no agreement in 49% (n=47). There was disease group agreement in 66% of cases (n=63). Nearly a quarter (23%) of participating patients could have safely been managed without an in-person visit to a dermatologist.
authors.affiliation: Department of Medical Informatics, Academic Medical Centre, Amsterdam, The Netherlands. n.eminovic@amc.uva.nl
authors.forename: N
authors.initials: N
authors.lastname: Eminović
authors.forename: L
authors.initials: L
authors.lastname: Witkamp
authors.forename: A C J
authors.initials: AC
authors.lastname: Ravelli
authors.forename: J D
authors.initials: JD
authors.lastname: Bos
authors.forename: Th W
authors.initials: TW
authors.lastname: van den Akker
authors.forename: M T
authors.initials: MT
authors.lastname: Bousema
authors.forename: C J M
authors.initials: CJ
authors.lastname: Henquet
authors.forename: R J J
authors.initials: RJ
authors.lastname: Koopman
authors.forename: J E
authors.initials: JE
authors.lastname: Zeegelaar
authors.forename: J C
authors.initials: JC
authors.lastname: Wyatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003880:Dermatology / Q000592:standards*; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D010865:Pilot Projects; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019114:Remote Consultation / Q000592:standards; D015203:Reproducibility of Results; D012871:Skin Diseases / Q000175:diagnosis*; D017216:Telemedicine / Q000592:standards*