Evidence Review Suggests Clinic Dermatology Provides Better Accuracy than Teledermatology
Due to the visual nature of a skin examination, telemedicine, specifically teledermatology, is a potentially valuable tool in the diagnosis and management of dermatologic diseases, especially in rural areas where specialty services may not be available. Two particular types of teledermatology are commonly employed: 1) store-and-forward (SAF) uses digital image technology that is communicated similarly to e-mail; and 2) real-time or live interactive (LI) uses video-conference technology; participants are separated by space but not time. This systematic review of the scientific literature sought to compare teledermatology and clinic dermatology in several key areas: diagnostic accuracy/concordance, management accuracy/concordance, clinical outcomes, and costs. Investigators analyzed 78 studies published between 1990 and June 2009.
- Of the 78 studies included in this review of the evidence, about two-thirds comparing teledermatology and clinic dermatology found better diagnostic accuracy with clinic dermatology.
- Diagnostic concordance between store-and-forward and clinic dermatology was fair. Concordance rates between real-time or live teledermatology compared to clinic dermatology were higher, but were based on fewer patients.
- Overall rates of management accuracy were equivalent, but teledermatology was inferior to clinic dermatology for malignant lesions. Management concordance was fair to excellent.
- There was insufficient evidence to evaluate clinical course outcomes, but patient satisfaction and preferences were comparable.
- Teledermatology did reduce time to treatment and clinic visits, and it was cost-effective – if certain assumptions were met (i.e., patient travel distance, costs of clinic dermatology).
- Barriers to the implementation of teledermatology and key factors for success are highly dependent upon the intended setting and are critical to successful implementation. This review was not designed to address these important aspects of teledermatology.
- The authors suggest that the benefits of teledermatology be evaluated in the context of potential limitations. Also, because teledermatology involves a shift in the workload, ongoing support (i.e., funding for technicians, training for primary care providers, additional staff) is critical.
This study was funded through HSR&D’s Evidence Synthesis Program (ESP 09-009). All authors are part of HSR&D’s Center for Chronic Disease Outcomes Research, Minneapolis, MN.
Warshaw E, Hillman Y, Greer N, et al. Teledermatology for Diagnosis and Management of Skin Conditions: A Systematic Review. Journal of the American Academy of Dermatology October 29, 2010;e-pub ahead of print.