Evaluation of electronic consults for outpatient pediatric patients with dermatologic complaints

Abstract

Background: Although dermatologic complaints are frequently encountered by pediatricians, access to pediatric dermatologists remains limited. Teledermatology has been proposed to expand access to dermatologic care for children. We report our experience with a physician-to-physician store-and-forward teledermatology service (eConsults), focusing on patient and consult characteristics and their relationship with teledermatologist confidence and follow-up recommendations as well as clinical outcomes. Methods:We reviewed electronic health records of all pediatric patients referred through eConsults at the Massachusetts General Hospital from 1/13/2020 to 7/17/2020. We assessed pediatrician and parental receptiveness with a confidential survey.Results: A total of 302 referrals (median patient age 4.6 years (IQR 0.6-12); 54% female) and 310 cases were completed in 1.8 days on average (SD = 1.2). Teledermatologists rated their confidence as definite and moderate in 51.3% and 39.4% cases, respectively. Teledermatologists felt comfortable managing rashes remotely, but patients with alopecia, pigmented and vascular lesions, and warts frequently required formal dermatology evaluation. Among patients seen subsequently, full concordance was seen for 70.1% of diagnoses and 74.4% of management recommendations. All responding pediatricians were satisfied with the service, and 97.5% felt that the parents were receptive to it. Conclusions:Our study supports the growing evidence that store-and-forward teledermatology can quickly and effectively provide the access to pediatric dermatologic care and is well received by pediatricians and parents. To maximize cost-effectiveness of store-and-forward teledermatology, dermatologists should work with referring providers to improve the quality of submitted photographs and patient history as well as advise in-person referrals for cases likely to require further follow-up.

Home treatment of single cutaneous warts combining face‐to‐face and teledermatology consultation: A new perspective

“…2 During the present COVID-19 pandemic, teledermatology has demonstrated to be a safe and effective substitute to face-to-face visit for the remote assessment and management of many office dermatoses, including follow-up. [1][2][3][4][5] Cryotherapy represents one of the most common treatments for CWs. 6 As very low surface temperatures are generally obtained with common devices (À196 C for liquid nitrogen), it is traditionally performed by clinicians.…”

“…Teledermatology uses telecommunication to transmit medical information to a dermatologist by different modalities, including photographic images or live video teleconferencing 2 . During the present COVID‐19 pandemic, teledermatology has demonstrated to be a safe and effective substitute to face‐to‐face visit for the remote assessment and management of many office dermatoses, including follow‐up 1–5 …”

Evaluation of a pediatric dermatology electronic consult program in a rural state with subanalysis of infantile hemangioma cases

“…This allowed for delivery of information on preselection, secure acquisition and upload of highquality clinical and dermoscopic images, which were previously reported barriers to successful teledermatology programs. 11,12 Infrastructure barriers were further reduced by utilizing the existing EMR and providing dermatoscopes and image capture devices to each site. We share our e-Consult program evaluation with the hope of encouraging others to embrace SAF e-Consult with dermoscopy to improve access for pediatric dermatology patients.…”

Access to pediatric dermatology

“…The American Academy of Dermatology (AAD) has implemented a free, provider-to-provider SAF teledermatology program to expand access to underserved communities [68]. In adult and pediatric studies, diagnostic and management concordance is high for SAF, ranging between 77–79% and 74.4–82%, respectively [64 ▪ ,69 ▪ ]. As evaluated in adults, teledermoscopy can supplement the virtual evaluation of pigmented lesions [57].…”

“…Like synchronous teledermatology, the appropriateness of SAF varies by diagnosis and patient complexity; pediatric teledermatologists are comfortable managing rashes using SAF, whereas alopecia, pigmented and vascular lesions, and warts frequently require live evaluation [69 ▪ ]. SAF patch testing has been studied in adults; clinically significant discrepancies between in-person dermatologist and teledermatologist evaluation were observed in up to 29.1% of final interpretations [70 ▪ ].…”