title: Implementation and evaluation of Stanford Health Care direct-care teledermatology program.
abstract: BACKGROUND
  Teledermatology has proven to be an effective means of providing dermatologic care. The existing research has primarily evaluated its usefulness in a consultative model. Few academic centers have evaluated a patient-initiated model, and direct-to-consumer services remain the subject of controversy. Stanford Health Care recently launched a direct-care, patient-initiated teledermatology pilot program. This article evaluates the viability and patient satisfaction with this service.
  
  
  METHODS
  During the pilot period, patients were able to seek remote dermatologic care using an eVisit tool in their MyHealth account. Patients initiated the consultation, answered questions regarding their complaint, and uploaded a picture if relevant. A Stanford dermatologist reviewed each eVisit and responded with an assessment and plan. The dermatologist noted whether they were able to make a diagnosis and their level of confidence in it. After the study, 10 patients participated in a focus group to provide feedback on the service.
  
  
  RESULTS
  In all, 38 patients sought care during the pilot period. A dermatologist was able to make a diagnosis in 36 of 38 (95%) cases, with an average confidence level of 7.9 of 10. The average time to consultation was 0.8 days. Patients indicated high levels of satisfaction with the service although they had suggestions for improvement.
  
  
  CONCLUSIONS
  Patients provided clinically useful images and information in a direct-care teledermatology model. Such services allow dermatology providers to increase access while maintaining high-quality care in an academic medical center. Further research is needed on standalone services that cannot integrate encounters with the patient's existing medical record.
authors: Stanford University School of Medicine, Stanford, CA, USA.
authors: Akhilesh S
authors: AS
authors: Pathipati
authors: Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA.
authors: Justin M
authors: JM
authors: Ko
keywords: Dermatology; direct-to-consumer telehealth; teledermatology; telemedicine