Derm Consult for Inpatients? There’s an App for That
Feb 13, 2014
Diagnostic apps for dermatologists are no new smartphone feature, and online outpatient consultations have been going on for years in the U.S. and abroad, but now, dermatologists may be able to triage inpatients remotely via a smartphone app.
In a new study published online in JAMA Dermatology, Misha Rosenbach, MD, of the University of Pennsylvania in Philadelphia, and colleagues, tested the use of a “store-and-forward” teledermatology smartphone app to triage 50 adult inpatients in need of a dermatology consultation.
In an accompanying editorial, Lindy P. Fox, MD, of the University of California San Francisco, noted that only 51% of patients admitted to the hospital for a dermatologic-specific condition actually receive a dermatologic consultation.
And, according to Fox, only 24% of nondermatologists consulting teams make an accurate initial dermatologic diagnosis; changes in diagnosis or treatment once a dermatologist consultation shows up occur in “up to 77%” of cases.
Then why don’t hospitals have an on-call dermatologist if misdiagnosis is so rampant?
Fox attributes this to workforce shortages in the field of dermatology, a lack of dermatologists in the hospital setting due to low financial incentives, “unease caring for the diseases seen in hospitalized patients,” and frustrations with “inefficiencies and burdens” involved with inpatient care, not the least of which involves interfacing with electronic medical record systems.
Makes one wonder, do any other specialists feel this way about working in a hospital setting?
Fox sees teledermatology apps as a bridge to cover the gap in derma consults, because they create access without the aforementioned hassles.
However, there are notable issues with telehealth, since confidentiality and security are subject to technology breaches.
This particular app was used only by hospital staff and remote physicians, as opposed to patient operators. But still, telehealth via smartphone app is a platform ripe for security mishaps regardless of the user.
For Rosenbach’s study, each inpatient was evaluated in person by a dermatologist and remotely by two teledermatologists using the teledermatology app. Nearly half of the patients, 48%, had cancer, 34% were in the hospital for an immunosuppression condition, 12% had heart failure, and 52% were on IV antibiotics.
Results showed that when the in-person dermatologist recommended the patient be seen that day, the teledermatologist made the same recommendation 90% of the time. If a biopsy was recommended by the in-person consult, the teledermatologist agreed 95% of the time.
One reported difference between in-person and teledermatology consults was that the telederms were more conservative in treatment and requested more biopsies.
The other major difference between consults were variations in treatment recommendations and biopsies for patients with known dermatologic conditions or drug reactions.
Both of these differences could be a result of overcompensation with regard to concerns over missing something as a remote operator.
For teledermatology to work, Fox wrote, standardized information gathering and presentation are necessary.
“The next step is to validate the assumption that the use of teledermatology in the inpatient setting leads to increased efficiency, improved access, better outcomes, and decreased costs while still delivering quality care,” Fox wrote.
In less than 10% of cases in Rosenbach’s study, the teledermatologists failed to triage a consultation to be seen the same day when the in-person dermatologist believed it was necessary.
This was a small, single, academic-center study, so future analysis will be necessary to determine whether teledermatology could or should be implemented on a large scale or in community centers.