Patient Initiated Store and Forward Teledermatology: A Single Practice Experience

We report a retrospective chart review of 112 images submitted from 85 patients through the Epic electronic medial record to determine disposition of patient complaints and to estimate cost savings. The study represents a single practice at a tertiary care university practice. Sixty (53.6%) were resolved electronically. The remaining 52 (46.4%) were deemed to require an in-person office visit. Of the 60 electronically resolved, 23 (38.3%) involved reassurance of a self-limited condition while 37 (61.7%) involved prescription management. The encounters resolved through MyChart were not billed and provided a cost savings of $2,052.29 and $4,664.96 for Level 3 and 4 office visit equivalents, respectively, for a total of $6,717.25. Patients needing an office visit were on average seen 18.3 days from the date of photo submission. After adjusting for patient-initiated rescheduling of the earliest appointment date provided, this was slightly reduced to 16.0 days. We observed diagnostic concordance in 88/112 (78.6%) eConsults. Krippendorff's alpha was 0.773 (95% confidence interval of 0.691- 0.846), indicating a tentative conclusion of modest reliability between the two raters.5 Concordance regarding the need for an appointment as determined by the two raters was observed in 71/112 (63.4%) eConsults. We conclude that patient-submitted eConsults is a viable means of resolving just over half of patient-submitted dermatologic concerns while offering cost savings; there is modest inter-rater reliability.