TELEMEDICINE EVALUATION OF CUTANEOUS DISEASES - A BLINDED COMPARATIVE-STUDY

Background: Numerous telemedicine programs have been created in the Un ited States, but studies documenting the fidelity and effectiveness of telemedicine for evaluation of skin diseases are lacking, Objective: We attempted to determine the percentage of encounters in which two di fferent dermatologists, one using telemedicine and one on-site, could independently arrive at the same primary diagnosis. Methods: Two clini cal telemedicine sites linked through the Georgia Statewide Telemedici ne Program were used in this study of 60 patients with skin problems, One dermatologist evaluated the patients on telemedicine (interactive television) and a second then took the patients into a separate examin ation room and evaluated them on-site. Each investigator recorded thei r diagnoses with no discussion with each other. As a control group, th e investigators independently and in a blinded fashion (to each other' s diagnoses) recorded diagnoses for a group of patients from a third d ermatologist's clinic. Raw data were evaluated and classified by this third dermatologist who assigned diagnoses to categories of complete a greement, partial agreement, or disagreement. Results: There were no s ignificant differences with regard to disagreement. However, there was a higher probability of complete agreement between the two dermatolog ists when each examined the patient on-site and in person than when on e evaluated the patient on telemedicine and one examined the patient o n site and in person. Conclusion: Our results suggest that telemedicin e is an effective means of diagnosing cutaneous diseases, However, bec ause partial interobserver agreement on diagnoses was greater for the telemedicine group than for the control group (p < 0.05), it is likely that optimum use of medical assistants at the remote site will be nec essary to increase the likelihood of complete agreement on diagnoses a mong dermatologists using interactive television.