Objective: To investigate the diagnostic accuracy of clinicians viewin
g a patient's history and static digital image set compared with clini
cians who conducted office-based physical examinations of the same pat
ients. Design: Observational study. Setting and Patients: One hundred
sixteen adult patients presenting with dermatologic symptoms in a univ
ersity-based practice who consented to have their skin conditions docu
mented with a still digital camera according to a standardized protoco
l. Main Outcome Measures: Concordance between office-based dermatologi
sts' diagnoses and 2 remote clinicians' diagnoses using still digital
images (resolution, 92 dots per inch) and identical medical history da
ta to render diagnoses. Results: When photographic quality was high an
d office-based clinician certainty was high, remote clinicians were in
agreement more than 75% of the time. Office-based and remote clinicia
ns were in agreement 61% to 64% of the time for all cases. No specific
disease category appeared to be more or less amenable to diagnosis ba
sed on still digital imagery. The diagnostic certainty of the office-b
ased clinician (reported from 0-10) had the most impact on agreement.
When cases with office-based clinician certainty of no more than 7 wer
e compared with cases with certainty of at least 9, agreement increase
d 54% for remote clinician 1 and 111% for remote clinician 2. As an is
olated variable, photographic quality had a modest impact on agreement
. Conclusions: Still digital images can substitute for the dermatologi
c physical examination in up to 83% of cases. This study provides vali
dation of the store-and-forward concept of telemedicine as applied to
dermatology. These results serve as the foundation for field testing o
f the concept in primary care settings.