title: Diagnostic performance of a telemedicine system for ophthalmology: advantages in accuracy and speed compared to standard care.
abstract: Telemedicine has potential to improve quality and delivery of medical care, particularly in image-oriented specialties where decisions are based on appearance of morphological features during examination. In the ophthalmology domain, nearly all published telemedicine studies have measured accuracy against a gold standard of ophthalmoscopic examination. The purposes of this study are to examine difficulties in defining an absolute gold standard and to compare diagnostic speed in a representative disease, retinopathy of prematurity. We compare results from ophthalmoscopic and telemedicine examinations by the same physicians. In 180 (86.5%) of 208 eyes, the two examinations produced the same diagnosis. In some discrepancies, there was rationale suggesting that telemedicine may have provided a more accurate diagnosis than ophthalmoscopic examination. The quantity and nature of these disagreements has important implications for evaluation of telemedicine systems in image-based specialties, and for the definition of gold standards in future studies.
authors.affiliation: Departments of Biomedical Informatics.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: David
authors.initials: D
authors.lastname: Kim
authors.forename: Karen
authors.initials: K
authors.lastname: Scott
authors.forename: Grace
authors.initials: G
authors.lastname: Richter
authors.forename: Steven
authors.initials: S
authors.lastname: Kane
authors.forename: John
authors.initials: J
authors.lastname: Flynn
authors.forename: Justin
authors.initials: J
authors.lastname: Starren
mesh_terms: D006801:Humans; D009885:Ophthalmology; D009887:Ophthalmoscopy; D012178:Retinopathy of Prematurity / Q000175:diagnosis; D017216:Telemedicine