Teledermatology in the nursing home

To examine a still-image store-and-forward teledermatology system for use in the care of nursing home residents.

Diagnosis and treatment plans made from a teledermatology system were compared with those made from an on-site dermatology consultation.

This study involved the dermatologic care of nursing home residents.

Dermatologic consultations sent to the senior author's office from the participating nursing home were eligible for the study. In a consecutive manner, 29 residents with a total of 30 skin conditions were enrolled.

A nurse collected and sent the histories and images using the teledermatology system. A diagnosis and treatment plan was determined by examining a transmitted still image and patient history alone and in combination by 2 to 3 dermatologists independently. An independent dermatologist made an on-site dermatologic consultation within 2 days after the images had been collected.

The diagnosis and treatment plans made from the teledermatology system were compared with those made by the on-site dermatologist.

Twenty-nine patients with 30 skin conditions were enrolled in the study. Correct diagnoses were made for 60 (67%) of 90, 51 (85%) of 60, and 53 (88%) of 60 patients given the history alone, image alone, and both, respectively. The correct treatment plan was seen in 63 (70%) of 90, 52 (87%) of 60, and 54 (90%) of 60 patients given the history alone, image alone, and both, respectively. No incorrect diagnoses or treatment plans would have given rise to substantial morbidity. The dermatologists felt comfortable in making a diagnosis and treatment plan in all cases in which they had access to both the image and patient history.

This study provides evidence that nursing home teledermatology consults may replace some on-site consultations by offering quality care in a cost-effective manner.