Teledermatology: Outcomes and Economic Considerations

Abstract

IntroductionTeledermatology is defined as the provision of dermatologic care through the use of communications technology (Goldyne & Armstrong, 2010). It offers many benefits that include increased access to dermatologic services and potential reduction in costs associated with care. Teledermatology is traditionally categorized into two different models based on the technology that is employed: store-and-forward (S&F) teledermatology, and live, interactive (LI) teledermatology (Goldyne & Armstrong, 2010). While hybrid models (a combination of S&F and LI technology) are practiced at selected institutions, this chapter focuses primarily on S&F and LI models. We will present operational flows of these two technology-enabled modalities, common outcomes measures used for evaluation of teledermatology quality metrics, and economic analyses. At the end of the chapter (in section 5), we will consider a novel, technology-independent framework for categorizing teledermatology models as well. This system relies on classification of teledermatology based on healthcare delivery models, and serves as an alternative way to organize and evaluate the provision of teledermatologic care. Store-and-forward teledermatologyStore-and-forward teledermatology is an asynchronous means for providing dermatologic care, as it relies on the asynchronous transmission of static digital images, patient histories, and specialist recommendations rather than real-time interaction between the specialist and the patient (Goldyne & Armstrong, 2010). In the S&F model, a medical staff personnel at the referral site typically takes images of the relevant skin condition and obtains medical history. This information is then sent to a dermatologist via a secure internet connection. The dermatologist evaluates the patient's condition asynchronously and transmits the recommendations back to the primary care provider at the referral site (Pak et al., 2009). Outcomes measures of store-and-forward teledermatologyTeledermatology studies have assessed numerous outcomes measures, including learning effects, length of consultation, and technical aspects (Eminovic et al., 2007). We will focus this discussion on four extensively used outcomes measures: diagnostic accuracy, diagnostic reliability, clinical outcomes, and satisfaction.

Implementation and evaluation of Stanford Health Care direct-care teledermatology program

“…These include increased access to care without compromising quality and potentially decreased healthcare costs. 1–8 These benefits have been widely discussed in previous studies so we will not dwell on them here. Instead, we will focus this discussion on the unique elements of our model, compared to both traditional consultative teledermatology and other patient-initiated services.…”

“…Studies suggest that teledermatology has successful outcomes in terms of diagnostic accuracy and reliability, access to care, clinical outcomes, and satisfaction. 2–6 Teledermatology is also cost-effective, especially when approached from a societal perspective (which accounts for the time savings and convenience of a virtual visit). 7,8…”

Feasibility of teledermatology in the eradication of leishmaniasis from Yemen project

“…Generally, teledermatology can be categorized, upon the utilized technology, platform and application used, into three main types, (1) live-interactive (synchronous) teledermatology; (2) store-forward (asynchronous) teledermatology; and (3) Hybrid (combined) teledermatology [1].…”