Objective We performed a systematic review of the literature addressing teledermatology: (1) diagnostic accuracy/concordance; (2) management accuracy/concordance; (3) clinical outcomes; and (4) costs. Methods Peer-reviewed controlled trials published in English between 1990 and 2009 were identified through MEDLINE and PubMed searches. Results Of 78 included studies, approximately two-thirds comparing teledermatology and clinic dermatology found better diagnostic accuracy with clinic dermatology. Diagnostic concordance of store and forward with clinic dermatology was good; concordance rates for live interactive and clinic dermatology were higher, but based on fewer patients. Overall rates of management accuracy were equivalent, but teledermatology and teledermatoscopy were inferior to clinic dermatology for malignant lesions. Management concordance was fair to excellent. There was insufficient evidence to evaluate clinical course outcomes. Patient satisfaction and preferences were comparable. Teledermatology reduced time to treatment and clinic visits and was cost-effective if certain assumptions were met. Limitations Heterogeneity in studies (design, skin conditions, outcomes) limited the ability to pool data. Conclusion The benefits of teledermatology need to be evaluated in the context of potential limitations.

Teledermatology for diagnosis and management of skin conditions: A systematic review

OBJECTIVE
We performed a systematic review of the literature addressing teledermatology: (1) diagnostic accuracy/concordance; (2) management accuracy/concordance; (3) clinical outcomes; and (4) costs.


METHODS
Peer-reviewed controlled trials published in English between 1990 and 2009 were identified through MEDLINE and PubMed searches.


RESULTS
Of 78 included studies, approximately two-thirds comparing teledermatology and clinic dermatology found better diagnostic accuracy with clinic dermatology. Diagnostic concordance of store and forward with clinic dermatology was good; concordance rates for live interactive and clinic dermatology were higher, but based on fewer patients. Overall rates of management accuracy were equivalent, but teledermatology and teledermatoscopy were inferior to clinic dermatology for malignant lesions. Management concordance was fair to excellent. There was insufficient evidence to evaluate clinical course outcomes. Patient satisfaction and preferences were comparable. Teledermatology reduced time to treatment and clinic visits and was cost-effective if certain assumptions were met.


LIMITATIONS
Heterogeneity in studies (design, skin conditions, outcomes) limited the ability to pool data.


CONCLUSION
The benefits of teledermatology need to be evaluated in the context of potential limitations.

Teledermatology for Diagnosis and Management of Skin Conditions: A Systematic Review of the Evidence

Teledermatology consultations can be performed using either store-and-forward or real-time technology. The best-studied aspect of teledermatology is diagnostic reliability, also known as diagnostic agreement. A good level of diagnostic reliability is achieved by dermatologists using both store-and-forward and real-time modalities and is comparable to that found between clinic-based examiners. Less information is available regarding diagnostic accuracy. Current data suggest that teledermatologists reviewing store-and-forward consults achieve accuracy comparable to that of clinic-based dermatologists. When store-and-forward consult systems are used, approximately one in four in-person clinic appointments are averted. Real-time consult systems avoid the need to schedule approximately one in two clinic visits. Store-and-forward technology results in timelier interventions for patients when compared to a conventional referral process. To date, surveys of both store-and-forward and real-time teledermatology consult modalities suggest that patients, referring clinicians, and dermatologists are all highly satisfied with teledermatology consults. Very little has been published about the economic impact of store-and-forward teledermatology, whereas several studies have evaluated real-time modalities. Teledermatology has ranged from a cost-saving strategy to an intervention that incurs greater costs than conventional care, depending on the health care setting and economic perspective. Future research focusing on diagnostic accuracy, clinical outcomes using clinical course or disease status as outcome measures, development of reliable and valid teledermatology-specific survey instruments, and economic analyses that assess cost-effectiveness will help guide future teledermatology program assessments and policy.

Teledermatology research review.

Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation The objective of this article was to identify the use of teledermatology across the world based on published original articles A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted Search results were reviewed systematically The search resulted in 204 publications meeting the inclusion criteria for analysis The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value Teledermatology proved to be a reliable consultation tool in the majority of studies If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output Regarding indications, comparison with classic consultation and area of application, most studies were of general nature For precise determination of the value, systematic studies would be needed However, teledermatology is already accepted as a valid tool

Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review.

We conducted a systematic review of the literature to evaluate the efficacy of telemedicine for making diagnostic and management decisions in three classes of application: office/hospital-based, store-and-forward, and home-based telemedicine. We searched the MEDLINE, EMBASE, CINAHL and HealthSTAR databases and printed resources, and interviewed investigators in the field. We excluded studies where the service did not historically require face-to-face encounters (e.g. radiology or pathology diagnosis). A total of 58 articles met the inclusion criteria. The articles were summarized and graded for the quality and direction of the evidence. There were very few high-quality studies. The strongest evidence for the efficacy of telemedicine for diagnostic and management decisions came from the specialties of psychiatry and dermatology. There was also reasonable evidence that general medical history and physical examinations performed via telemedicine had relatively good sensitivity and specificity. Other specialties in which some evidence for efficacy existed were cardiology and certain areas of ophthalmology. Despite the widespread use of telemedicine in most major medical specialties, there is strong evidence in only a few of them that the diagnostic and management decisions provided by telemedicine are comparable to face-to-face care.

A systematic review of the efficacy of telemedicine for making diagnostic and management decisions.

Objective: To investigate the diagnostic accuracy of clinicians viewing a patient's history and static digital image set compared with clinicians who conducted officebased physical examinations of the same patients. Design: Observational study. Setting and Patients: One hundred sixteen adult patients presenting with dermatologic symptoms in a university-based practice who consented to have their skin conditions documented with a still digital camera according to a standardized protocol. Main Outcome Measures: Concordance between office-based dermatologists' diagnoses and 2 remote clinicians' diagnoses using still digital images (resolution, 92 dots per inch) and identical medical history data to render diagnoses. Results: When photographic quality was high and office-based clinician certainty was high, remote clinicians were in agreement more than 75% of the time. Office-based and remote clinicians were in agreement 61% to 64% of the time for all cases. No specific disease category appeared to be more or less amenable to diagnosis based on still digital imagery. The diagnostic certainty of the office-based clinician (reported from 0-10) had the most impact on agreement. When cases with office-based clinician certainty of no more than 7 were compared with cases with certainty of at least 9, agreement increased 54% for remote clinician 1 and 111% for remote clinician 2. As an isolated variable, photographic quality had a modest impact on agreement. Conclusions: Still digital images can substitute for the dermatologic physical examination in up to 83% of cases. This study provides validation of the store-and-forward concept of telemedicine as applied to dermatology. These results serve as the foundation for field testing of the concept in primary care settings. Arch Dermatol. 1997;133:161-167

The Substitution of Digital Images for Dermatologic Physical Examination

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The Substitution of Digital Images for Dermatologic Physical Examination