Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease

Colleen K Gabel; Emily Nguyen; Ryan Karmouta; Kristina Jing Liu; Guohai Zhou; Allireza Alloo; Ryan Arakaki; Yevgeniy Balagula; Alina G Bridges; Edward W Cowen; Mark Denis P Davis; Alisa Femia; Joanna Harp; Benjamin Kaffenberger; Jesse J Keller; Bernice Y Kwong; Alina Markova; Melissa Mauskar; Robert Micheletti; Arash Mostaghimi; Joseph Pierson; Misha Rosenbach; Zachary Schwager; Lucia Seminario-Vidal; Victoria R Sharon; Philip I Song; Lindsay C Strowd; Andrew C Walls; Karolyn A Wanat; David A Wetter; Scott Worswick; Carolyn Ziemer; Joseph Kvedar; Anar Mikailov; Daniela Kroshinsky

doi:10.1016/j.jaad.2020.04.171

. 2020 May 7. Online ahead of print. doi: 10.1016/j.jaad.2020.04.171

Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.

Colleen K Gabel ^1,^∗, Emily Nguyen ^1,^∗, Ryan Karmouta ², Kristina Jing Liu ³, Guohai Zhou ⁴, Allireza Alloo ⁵, Ryan Arakaki ⁶, Yevgeniy Balagula ⁷, Alina G Bridges ⁸, Edward W Cowen ⁹, Mark Denis P Davis ⁸, Alisa Femia ¹⁰, Joanna Harp ¹¹, Benjamin Kaffenberger ¹², Jesse J Keller ¹³, Bernice Y Kwong ¹⁴, Alina Markova ¹⁵, Melissa Mauskar ¹⁶, Robert Micheletti ¹⁷, Arash Mostaghimi ⁴, Joseph Pierson ¹⁸, Misha Rosenbach ¹⁷, Zachary Schwager ¹⁹, Lucia Seminario-Vidal ²⁰, Victoria R Sharon ⁵, Philip I Song ²¹, Lindsay C Strowd ²², Andrew C Walls ⁴, Karolyn A Wanat ²³, David A Wetter ⁸, Scott Worswick ²⁴, Carolyn Ziemer ²⁵, Joseph Kvedar ¹, Anar Mikailov ²⁶, Daniela Kroshinsky ^1,^∗∗

¹Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, United States

²Division of Dermatology, University of California Los Angeles, Los Angeles, California, United States

³Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States

⁴Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, Massachusetts, United States

⁵Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York

⁶Department of Dermatology, University of California San Francisco, San Francisco, California

⁷Department of Medicine, Division of Dermatology, Montefiore Medical Center, Bronx, New York

⁸Department of Dermatology, Mayo Clinic, Rochester, Minnesota

⁹Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland

¹⁰Department of Dermatology, New York University School of Medicine, New York, New York

¹¹Department of Dermatology, Weill Cornell Medicine, New York, New York

¹²Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio

¹³Department of Dermatology, Oregon Health and Science University, Portland, Oregon

¹⁴Department of Dermatology, Stanford University School of Medicine, Stanford, California

¹⁵Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York

¹⁶Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas

¹⁷Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

¹⁸Dermatology Division, University of Vermont Medical Center, Burlington, Vermont

¹⁹Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts

²⁰Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida

²¹Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, California

²²Department of Dermatology, Wake Forest Baptist Health, Winston-Salem, North Carolina

²³Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin

²⁴Department of Dermatology, Keck School of Medicine at the University of Southern California, Los Angeles, California

²⁵Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina

²⁶Department of Dermatology, Beth Israel Lahey Health, Burlington, Massachusetts

^∗∗

Corresponding Author: Daniela Kroshinsky, MD, MPH Department of Dermatology, Massachusetts General Hospital 50 Staniford Street, 2nd Floor Boston, MA 02114 (USA) Phone (617) 643-3884 dkroshinsky@partners.org

^∗

These two authors contributed equally to this work

PMCID: PMC7204758 PMID: 32389716

Abstract

Background

Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data.

Methods

This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic.

Results

There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median kappa = 0.83), substantial agreement in laboratory work-up decisions (median kappa = 0.67), almost perfect agreement in imaging decisions (median kappa = 1.0), and moderate agreement in biopsy decisions (median kappa = 0.43). There was almost perfect agreement in treatment (median kappa = 1.0), but no agreement in follow-up planning (median kappa = 0.0). There was no association between raw photo quality and the primary plus differential diagnosis or primary diagnosis alone.

Limitations

Selection bias and single-center nature.

Conclusions

Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.

Keywords: inpatient dermatology, teledermatology, dermatology consultations, store-and-forward, telemedicine, dermatology hospitalists

Footnotes

Funding Sources: None

Conflicts of Interest: None declared.

IRB approval status: Reviewed and approved by Partners IRB: 2018P002762

- Inpatient access to dermatologists is limited, highlighting an opportunity to utilize teledermatology within the inpatient setting.

- Teledermatology in the inpatient setting may be a clinically acceptable option for diagnosis, evaluation, and management. This may represent a novel and effective option for hospitals.

PERMALINK

Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.

Colleen K Gabel, BS

Emily Nguyen, BS

Ryan Karmouta, MD, MBA

Kristina Jing Liu, MD, MHS

Guohai Zhou, PhD

Allireza Alloo, MD

Ryan Arakaki, MD

Yevgeniy Balagula, MD

Alina G Bridges, DO

Edward W Cowen, MD, MHSc

Mark Denis P Davis, MD

Alisa Femia, MD

Joanna Harp, MD

Benjamin Kaffenberger, MD

Jesse J Keller, MD

Bernice Y Kwong, MD

Alina Markova, MD

Melissa Mauskar, MD

Robert Micheletti, MD

Arash Mostaghimi, MD, MPH

Joseph Pierson, MD

Misha Rosenbach, MD

Zachary Schwager, MD

Lucia Seminario-Vidal, MD, PhD

Victoria R Sharon, MD, DTMH

Philip I Song, MD

Lindsay C Strowd, MD

Andrew C Walls, MD

Karolyn A Wanat, MD

David A Wetter, MD

Scott Worswick, MD

Carolyn Ziemer, MD, MPH

Joseph Kvedar, MD

Anar Mikailov, MD

Daniela Kroshinsky, MD, MPH

Abstract

Background

Methods

Results

Limitations

Conclusions

Footnotes

ACTIONS

PERMALINK

RESOURCES

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