An assessment of the potential effect of a teledermatology system

The potential effect of a commercial teledermatology system was assessed. The system allowed general practitioners to send dermatologists a set of digital images, accompanied by a short patient history. Patients were seen, in the normal way, by consultant dermatologists. The system was then used to capture a set of images. These were viewed by two dermatologists, 13 months later. Reasonably high levels of agreement were found between the dermatologist seeing the patient and the dermatologist using the telemedicine system (77%). The two dermatologists were also asked to indicate whether, had the system been in use, the patient would have been seen urgently or routinely, or whether the general practitioner would have been advised that an outpatient appointment was not required. The results showed that fewer patients would have been called for urgent appointments (32% compared with 64%) and that 31% of cases could have been managed by the general practitioner. Assuming that the introduction of the system would have had no effect on the overall number of referrals, nor on the number of follow-up appointments, these figures suggest that the total number of appointments could be cut by 13%. It took approximately an hour to view 20 cases and it would be necessary to devote one consultant session a week to viewing images. This system would therefore not lead to significant savings, nor reduce the waiting list for outpatient appointments. The idea would have potential if the review of images could be made as easy as the triage of referral letters.