Teledermatololgy As Triage Tool For Dermatology Hospital Consultation

Dr. Misha A. Rosenbach Assistant Professor of Dermatology Hospital of the University of Pennsylvania Section Editor, JAMA Dermatology Patient Interview with:
Dr. Misha A. Rosenbach
Assistant Professor of Dermatology Hospital of the University of Pennsylvania Section Editor,
JAMA Dermatology Patient Page What are the main findings of the study? Dr. Rosenbach: There is strong agreement between teledermatologists and in-person dermatologists when evaluating inpatients at a tertiary care academic hospital.  The primary aim of this study was to assess telederm as a triage tool.  Many dermatologists are not full-time hospitalists, but work in private practice or clinics which may be remote from affiliated hospitals.  The goal was to evaluate whether teledermatology could help those providers assess the acuity of inpatient consults.  There was strong concordance. If an in-person dermatologist felt a patient needed to be seen that day, the teledermatologists independently suggested the same course of action in 90 percent of cases. Similarly, if the in-person dermatologist felt an inpatient needed a biopsy, the teledermatologists agreed in 95 percent of cases. Moreover, when it came to specific diagnostic agreement, the inperson dermatologist evaluating the hospitalized inpatients and the teledermatologists evaluating images completely agreed on a diagnosis 82 percent of the time, and partially agreed in 88 percent of cases. This suggests that teledermatology can be used by remote providers to evaluate hospitalized inpatients in terms of the acuity of their skin issues.  This could allow remote providers to offer some patients with benign-appearing conditions outpatient appointments shortly after discharge, and could help consulting dermatologists batch appointments for one day that’s convenient for them to see all the non-acute inpatient consults which should be seen during a hospital stay, but don’t necessarily require same-day consultations.  Perhaps most importantly, dermatologists could recognize truly acute skin issues and realize the need to go in to see the patient in person for those urgent and emergent diagnoses. Were any of the findings unexpected?

Dr. Rosenbach: I think the very high rates of agreement, particularly the high rates of diagnostic agreement (secondary aim), were higher than maybe would have been predicted. What should clinicians and patients take away from your report?

Dr. Rosenbach: Dermatology is a critical branch of medicine. The skin is an organ, and, like any other, it can be sick. Sometimes the skin can be critically ill, and require rapid dermatology consultation, evaluation, and targeted treatment.  Sometimes skin findings are a sign of an internal, multi-system process.  Dermatology has a critical place within the hospital, in the inpatient setting.  Teledermatology may help expand access for patients to reach and be seen by a dermatologist, even when one is not available in person. Teledermatology seems to be an accurate tool for triaging inpatient consults, and given the high rates of diagnostic concordance in this pilot study, may offer a way to remotely diagnose and in some cases manage patients with skin disease when an in-person dermatologist is not available. What recommendations do you have for future research as a result of this study?

Dr. Rosenbach: This was a 50 patient pilot study, at a large academic medical center, evaluating sick, complex patients. To generalize the results, it should be repeated in a variety of settings (including community hospitals, and emergency rooms), and with larger numbers of patients. Citation: Barbieri JS, Nelson CA, James WD, et al. The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations. JAMA Dermatol. 2014;():. doi:10.1001/jamadermatol.2013.9517.

Last Updated on March 19, 2014 by Marie Benz MD FAAD