Health Services Implications of a Teledermatology Consult System
John D. Whited MD MHS
Harry S. Truman Memorial VA Medical Center
Columbia, MO
Funding Period: October 1999 - September 2003

BACKGROUND/RATIONALE:
We have previously shown (IIR 95-045) that teledermatology, using store and forward technology, can result in reliable and accurate diagnostic outcomes when compared to clinic-based dermatology consultations. This investigation builds on that fundamental diagnostic information by assessing the health services implications of a teledermatology consult system.

OBJECTIVE(S):
To investigate health services outcomes related to teledermatology implementation. Outcomes of interest were time to diagnosis and treatment initiation, the proportion of patients that avoided the need for a clinic-based encounter, and an economic analysis.

METHODS:
Patients referred from the primary care clinics to the dermatology consult service were randomized to either usual care or a teledermatology consultation. A usual care consultation consisted a conventional text-based electronic consult request. A teledermatology consultation included digital images and a standardized history, in addition to the electronic text-based consult. Consultant dermatologists, reviewing the consult requests for both modalities, decided when, and if, a referral required a clinic-based evaluation.

FINDINGS/RESULTS:
Two hundred seventy-five patients were randomized; 135 to teledermatology and 140 to usual care. The median time to diagnosis and treatment initiation in the usual care arm was 127 days compared to 41 days in the teledermatology arm (p = 0.0001) for the intervention to treat analysis and was 137.5 versus 50 days, respectively (p = 0.0027) for the actual visit analysis. In the teledermatology arm, 18.5% of the patients were not scheduled for a clinic visit. From the VA perspective, teledermatology was cost-effective for decreasing the time required for patients to reach a time to diagnosis and treatment initiation. Cost-effectiveness ratios ranged from $0.12-$0.17 per patient day of time to diagnosis and treatment initiation saved.

IMPACT:
Teledermatology consult systems can result in significantly shorter times to diagnosis and treatment initiation for patients compared to traditional consult modalities and, in some cases, the need for a clinic-based visit can be avoided. Teledermatology can achieve these outcomes in a cost-effective manner.

PUBLICATIONS:

Journal Articles

1. Whited JD. The quality of telemedicine research. Journal of Telemedicine and Telecare. 2006; 12(6): 271-3.
2. Whited JD. Teledermatology research review. International Journal of Dermatology. 2006; 45(3): 220-9.
3. Whited JD, Hall RP, Foy ME, Marbrey LE, Grambow SC, Dudley TK, Datta SK, Simel DL, Oddone EZ. Patient and clinician satisfaction with a store-and-forward teledermatology consult system. Telemedicine Journal and E-Health. 2004; 10(4): 422-31.
4. Whited JD, Datta S, Hall RP, Foy ME, Marbrey LE, Grambow SC, Dudley TK, Simel DL, Oddone EZ. An economic analysis of a store and forward teledermatology consult system. Telemedicine Journal and E-Health. 2003; 9(4): 351-60.
5. Whited JD, Hall RP, Foy ME, Marbrey LE, Grambow SC, Dudley TK, Datta S, Simel DL, Oddone EZ. Teledermatology's impact on time to intervention among referrals to a dermatology consult service. Telemedicine Journal and E-Health. 2002; 8(3): 313-21.
6. Whited JD. Teledermatology. Current status and future directions. American Journal of Clinical Dermatology. 2001; 2(2): 59-64.

DRA: Chronic Diseases, Health Services and Systems
DRE: Resource Use and Cost, Technology Development and Assessment
Keywords: Telemedicine
MeSH Terms: Randomized Controlled Trials, Telemedicine, Dermatology