The Value Of Teledermatology In Referring Dermatologists With Different Experience Levels

Background and objectTelemedicine is a new medical tool using modern telecommunication technology to exchange professional medical information. It can be applied between doctors and patients and between two remote medical institutions. Dermatology is a medical discipline with the most visible features. Many skin diseases can be accurately diagnosed only based on the morphology of skin lesions, which is what makes it the best target of telemedicine.As a branch of telemedicine, teledermatology has been demonstrated its feasibility and reliability in many studies. In particular, it has been proved that teledermatology is especially helpful for smaller departments of dermatology to obtain second opinion from expert dermatologists in the diagnosis of challenging skin conditions. Its technical systems include real-time video conferencing systems and store and forward systems (SAF system). The data is usually transmitted via e-mail or web using the second systems. Compared with the former, SAF system is comparatively quicker and costs less. Teledermatology can be used in several ways, For example, it may provide diagnosis and treatment services directly to the patient, or provide second diagnostic services to the doctor patient visited first, and so on. China is a vast country with great differences in medical resources in different areas, which means large cities have much better medical resources than small towns, especially the poor rural and remote areas. In adition, there are large number patients with skin diseases. Therefore, promoting the development of teledermatology may improve academic standards of the departments of dermatology in small towns and rural areas, reduce the regional difference in dermatology, and promote the healthy development of dermatology in China as well as. Although the feasibility and reliability of teledermatology has been proven in many studies, but we still need to do more randomized controlled trials and simulation studies to prove if teledermatology is a promising and low-cost subject.In this study, we collected 50 out-patients with skin disease warranting pathologic examination in the dermatology department of the First Affiliated Hospital of Zhengzhou University, in order to demonstrate whether there are difference in the value of teledermatology in the referring dermatology with different experience levels.Methods1. We collected consecutively 50 out-patients with skin warranting pathologic examination in the dermatology department of the First Affiliated Hospital of Zhengzhou University from March 24,2009 to June 25,2009. The diagnosis respectively rendered by a chief physician (Dong H) and an attending physician (Zhang F) after face-to-face seeing the patients were recorded as the first diagnosis. Then a postgraduate student (Li Y) collected the patients'medical history, took photographs of the lesions, collected the patients'pathologic results and excluded unqualified cases. Finally 38 cases were enrolled in the study. The patients'clinical images and clinical data were then uploaded at the discussion forum of http://www.telederm.org, a website provides freely available teleconsultation in dermatology, for discussion. Neither pathologic reports nor pathologic images were provided during discussion. The diagnosis separately made by the chief physician and the attending physician after referring to the discussion were regarded as the second diagnosis. The pathology of the patients was not available for both the chief physician and the attending physician before making the first and the second diagnosis. The diagnosis making after referring both the clinical data and pathologic diagnosis were considered as gold standard.2. Main outcome measures and statistics:We calculated the relative frequencies of the correct diagnosis of the chief and the attending physicians in the 38 patients for the both diagnostic sessions and compared statistically two physicians'the intra-observer differences of the accuracy rates between their own individual first and second sessions, respectively; and compared additionally the inter-observer differences of the accuracy rates of the two physicians'in the first and the second sessions, respectively.3. Statistical analysis:We used Microsoft Office Excel 2007 to input the recorded parameters. All the statistical analyses were performed with SPSS16.0. McNemar test was undertaken to compare the difference of the accuracy rates between and within the two physicians.α=0.05 was considered to be of statistical significance.Results1.38 cases were selected as eligible for the study. The accuracy rates of the chief physician's first and second diagnosis were 92.11% and 94.74%, respectively The accuracy rates of the attending physician's first and second diagnosis were 39.47% and 89.47%, respectively.2. The accuracy rate of the chief physician's the first diagnosis was not statistically significantly different from her second diagnosis (x2=0, P> 0.999). The first diagnosis'accuracy rate was significantly lower than the second diagnosis'accuracy in the attending physician (x2= 17.05, P<0.001). The accuracy rate of the chief physician'first diagnosis was significantly higher than the attending physician's (x 2=18.05, P< 0.001). The chief physician and the attending physician' second diagnosis accuracy rates had no difference in statistics (x2=0.5, P=0.500).Conclusions1. The attending dermatologist's independent diagnosis is less accurate than the chief dermatologist's independent diagnosis.2. With the assistance of teledermatology, an attending dermatologist with less expertise may achieve diagnosis accuracy comparable with that a chief dermatologist with expert expertise is able to obtain. 3. Teledermatology is more helpful in assisting a dermatologist with less expertise, while it's not that helpful in assisting a chief dermatologist in the field she has expertise.