title: Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform.
abstract: BACKGROUND
  In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system.
  
  
  METHODS
  We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases.
  
  
  RESULTS
  A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7-21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26-3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.
  
  
  CONCLUSIONS
  The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.
authors.affiliation: Dermatology Department, Hopital Nord , Marseille , France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Delaigue
authors.affiliation: Department of Dermatology, Sainte Anne Military Hospital , Toulon , France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Morand
authors.affiliation: Médecins Sans Frontières , New York, NY , USA.
authors.forename: David
authors.initials: D
authors.lastname: Olson
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway , Tromsø , Norway ; Faculty of Health Sciences, University of Tromsø , Tromsø , Norway.
authors.forename: Richard
authors.initials: R
authors.lastname: Wootton
authors.affiliation: Fondation Médecins Sans Frontières , Paris , France ; Department of Medical Ethics and Legal Medicine (EA 4569), Paris Descartes University , Paris , France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonnardot
keywords: LMICs; dermatology; low-resource settings; telehealth; telemedicine