title: Evaluation and comparison of store-and-forward teledermatology applications.
abstract: OBJECTIVE
  Store-and-forward (S&F) teledermatology has been used to increase patient access to dermatologic care. A major challenge to implementing S&F teledermatology is selecting secure and cost-saving applications for data capture and transmission. Detailed analyses and comparison of the major S&F teledermatology applications do not exist in the current peer-reviewed literature. The objectives of this study were to identify, evaluate, and compare the major S&F teledermatology applications in the United States to help referral and consultant sites select applications responsive to their needs.
  
  
  METHODS
  We identified four major, commercially available S&F teledermatology applications after surveying the members of the American Telemedicine Association Teledermatology Special Interest Group and the Telemedicine Task Force of the American Academy of Dermatology. A multidisciplinary team of dermatologists, primary care physicians, and information technologists established a set of criteria used to evaluate the applications. We performed a comparative analysis of the four major S&F teledermatology applications based on the predetermined evaluation criteria.
  
  
  RESULTS
  The four major, commercially available S&F teledermatology applications evaluated in this study were Alaska Federal Health Care Access Network, Medweb, TeleDerm Solutions, and Second Opinion. All four teledermatology applications were mature and capable of addressing the basic needs of S&F teledermatology referrals and consultations. Each application adopts different approaches to organize medical information and facilitate consultations. Areas in need of improvement common to these major applications include (1) increased compatibility and integration with established electronic medical record systems, (2) development of fully integrated billing capability, (3) simplifying user interface and allowing user-designed templates to communicate recommendations and patient education, and (4) reducing the cost of the applications.
  
  
  CONCLUSIONS
  The four major S&F teledermatology applications in the United States are versatile applications capable of facilitating communication between referral and consultant sites. Continued efforts in making these applications more secure, robust, user-friendly, and affordable will contribute to wider implementation of S&F teledermatology.
authors.affiliation: Department of Dermatology, University of California, Davis, Sacramento, California 95816, USA. aprilarmstrong@post.harvard.edu
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.forename: Christopher
authors.initials: C
authors.lastname: Sanders
authors.forename: Aron D
authors.initials: AD
authors.lastname: Farbstein
authors.forename: George Z
authors.initials: GZ
authors.lastname: Wu
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lin
authors.forename: Fu-Tong
authors.initials: FT
authors.lastname: Liu
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
mesh_terms: D002140:California; D016248:Computer Storage Devices; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D003880:Dermatology; D006297:Health Services Accessibility; D006801:Humans; D020407:Internet; D013677:Medical Laboratory Science; D012871:Skin Diseases / Q000175:diagnosis*; D012984:Software; D017216:Telemedicine / Q000295:instrumentation* / Q000458:organization & administration; D014481:United States; D014584:User-Computer Interface