Teledermatologie versus Konsildiagnosen — eine vergleichende Untersuchung von 120 Konsilen

Abstract

Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations. In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes. Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients' history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients' history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes. It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.

Externe wissenschaftliche Evaluation der ersten Teledermatologie-App ohne direkten Patientenkontakt in Deutschland („Online Hautarzt – AppDoc“)

“…Das Modellprojekt „Online Hautarzt – AppDoc“ ist die erste und bislang einzige unabhängig von der aktuellen Pandemiesituation genehmigte Lösung für teledermatologische Befundung ohne vorherigen Arztkontakt in Deutschland und wurde am 22.10.2018 von der Landesärztekammer Baden-Württemberg für 2 Jahre bewilligt. Vorangegangen waren zahlreiche Studien, die eine sehr gute diagnostische Präzision teledermatologischer Diagnosen zeigen konnten [ 4 , 7 , 9 , 16 ]. Der aktuelle Leitfaden zur Praxis der Teledermatologie der deutschsprachigen Dermatologen [ 2 ] empfiehlt, den Einsatz teledermatologischer Verfahren immer dann in Erwägung zu ziehen, wenn ein relevanter Zusatznutzen für die Patienten ohne relevante Nachteile für sie und die Versorgenden zu erwarten ist.…”

Digitale Zukunft als Chance – Teledermatologie-Erfahrungen aus der Praxis

“…Großes Potenzial bietet darüber hinaus die Vielfalt an Bildern von unterschiedlichen Hautläsionen. Diese könnendas Einverständnis der betroffenen Person vorausgesetztauch für Dokumentations-und Lehrzwecke eingesetzt werden [19].…”

Clinical quality management in telenuclear medicine

“…In such geographical regions with low population densities, where, for instance, "circuit riders" have been travelling from small town to small town in order to interpret imaging findings among all sorts of other tests, rapidity and competence of expert reading may be increased by distant access to medical data [3].Practical e-medicine applications include the follow-up of rare clinical conditions (telefollow-up), the seeking of a second opinion by rural (teleconsultation) or navy doctors (navy telemedicine), expert diagnosis of dermatological conditions (teledermatology) [4] and distant reading of radiological (teleradiology) or nuclear medicine images (telenuclear medicine). Moreover, continuous medical education programmes (tele-education) [5] may be based on evaluation of clinical or dermatological cases (dermanet) [6] or on live surgical procedures (telesurgery) [7]. Clinical applications have been described in the monitoring of cardiac parameters (telemonitoring or telecardiology), in the monitoring of under-served populations (telehomecare), in the surveillance of daily living activities in elderly people in nursing homes using an infrared motion detection system (telesurveillance) [8], in the screening of diabetic retinopathy using digital fundus photography, etc.Besides the broad concepts of "telemedicine" and "internet medicine", a ready-to-use "tele-terminology" covering diverse aspects of medical expertise is emerging, with original terms such as telespecialist, teledoctor, teleexpert, telepresence, telehealth and evidence-based telemedicine.…”

“…Practical e-medicine applications include the follow-up of rare clinical conditions (telefollow-up), the seeking of a second opinion by rural (teleconsultation) or navy doctors (navy telemedicine), expert diagnosis of dermatological conditions (teledermatology) [4] and distant reading of radiological (teleradiology) or nuclear medicine images (telenuclear medicine). Moreover, continuous medical education programmes (tele-education) [5] may be based on evaluation of clinical or dermatological cases (dermanet) [6] or on live surgical procedures (telesurgery) [7]. Clinical applications have been described in the monitoring of cardiac parameters (telemonitoring or telecardiology), in the monitoring of under-served populations (telehomecare), in the surveillance of daily living activities in elderly people in nursing homes using an infrared motion detection system (telesurveillance) [8], in the screening of diabetic retinopathy using digital fundus photography, etc.…”