Original Investigation |

The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations

John S. Barbieri, BA1; Caroline A. Nelson, BA1; William D. James, MD2; David J. Margolis, MD, MSCE, PhD1,2,3; Ryan Littman-Quinn, BA2; Carrie L. Kovarik, MD2; Misha Rosenbach, MD2
[+] Author Affiliations
1Perelman School of Medicine at the University of Pennsylvania, Philadelphia
2Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia
3Department of Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia
JAMA Dermatol. 2014;150(4):419-424. doi:10.1001/jamadermatol.2013.9517.
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Importance  Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospitalized patients.

Objective  To evaluate whether a store-and-forward teledermatology system is reliable for the initial triage of inpatient dermatology consultations.

Design, Setting, and Participants  Prospective study of 50 consenting adult patients, hospitalized for any indication, for whom an inpatient dermatology consultation was requested between September 1, 2012, and April 31, 2013, at the Hospital of the University of Pennsylvania, an academic medical center. The participants were evaluated separately by both an in-person dermatologist and 2 independent teledermatologists.

Main Outcomes and Measures  The primary study outcomes were the initial triage and decision to biopsy concordance between in-person and teledermatology evaluations.

Results  Triage decisions were as follows: if the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The Kendall τ rank correlation coefficients for initial triage concordance between the in-person dermatologist and teledermatologists were 0.41 and 0.48. The Cohen κ coefficients for decision to biopsy concordance were 0.35 and 0.61. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge.

Conclusions and Relevance  Teledermatology is reliable for the triage of inpatient dermatology consultations and has the potential to improve efficiency.

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Figure 1.
Triage Decisions

The bar graph shows the frequency of triage decisions for the in-person dermatologist and the teledermatologists. IP indicates in person; TD, teledermatologist.

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Figure 2.
Biopsy Decisions

The bar graph shows how frequently the in-person dermatologist and the teledermatologists decided to biopsy. IP indicates in person; TD, teledermatologist.

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