Reliability and accuracy of dermatologists' clinic-based and digital imageconsultations

Background: Telemedicine technology holds great promise for dermatologic he alth care delivery. However, the clinical outcomes of digital image consult ations (teledermatology) must be compared with traditional clinic-based con sultations. Objective: Our purpose was to assess and compare the reliability and accura cy of dermatologists' diagnoses and management recommendations for clinic-b ased and digital image consultations. Methods: One hundred sixty-eight lesions found among 129 patients were inde pendently examined by 2 clinic-based dermatologists and 3 different digital image dermatologist consultants. The reliability and accuracy of the exami ners' diagnoses and the reliability of their management recommendations wer e compared. Results: Proportion agreement among clinic-based examiners for their single most likely diagnosis was 0.54 (95% confidence interval [CI], 0.46-0.61) a nd was 0.92 (95% CI, 0.88-0.96) when ratings included differential diagnose s. Digital image consultants provided diagnoses that were comparably reliab le to the clinic-based examiners. Agreement on management recommendations w as variable. Digital image and clinic-based consultants displayed similar d iagnostic accuracy. Conclusion: Digital image consultations result in reliable and accurate dia gnostic outcomes when compared with traditional clinic-based consultations.