Utilization of telemedicine in the U.S. military in a deployed setting.
BACKGROUND
A retrospective evaluation of the Department of Defense teledermatology consultation program from 2004 to 2012 was performed, focusing on clinical application and outcome measures such as consult volume, response time, and medical evacuation status.


METHODS
A retrospective review of the teledermatology program between 2004 and 2012 was evaluated based on defined outcome measures. In addition, 658 teledermatology cases were reviewed to assess how the program was utilized by health care providers from 2011 to 2012.


RESULTS
As high as 98% of the teledermatology consults were answered within 24 hours, and 23% of consults within 1 hour. The most common final diagnoses included eczematous dermatitis, contact dermatitis, and evaluation for nonmelanoma skin cancer. The most common medications recommended included topical corticosteroids, oral antibiotics, antihistamines, and emollients. Biopsy was most commonly recommended for further evaluation. Following teleconsultation, 46 dermatologic evacuations were "avoided" as the patient was not evacuated based on the consultants' recommendation. Consultants' recommendations to the referring provider "facilitated" 41 evacuations.


CONCLUSIONS
Telemedicine in the U.S. military has provided valuable dermatology support to providers in remote locations by delivering appropriate and timely consultation for military service members and coalition partners. In addition to avoiding unnecessary medical evacuations, the program facilitated appropriate evacuations that may otherwise have been delayed.
San Antonio Uniformed Services Health Consortium, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Jane S
JS
Hwang
Southern Regional Medical Command, U.S. Army, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Charles M
CM
Lappan
Department of Dermatology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814.
Leonard C
LC
Sperling
Department of Dermatology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814.
Jon H
JH
Meyerle
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003877:Dermatitis, Contact / Q000175:diagnosis; D004485:Eczema / Q000175:diagnosis; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D019095:Point-of-Care Systems / Q000706:statistics & numerical data; D019114:Remote Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis*; D012874:Skin Diseases, Infectious / Q000175:diagnosis; D012878:Skin Neoplasms / Q000175:diagnosis; D014481:United States; D049269:Videoconferencing / Q000706:statistics & numerical data; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D006633:Histamine Antagonists