Telemedicine evaluation of cutaneous diseases: a blinded comparative study

Numerous telemedicine programs have been created in the United States, but studies documenting the fidelity and effectiveness of telemedicine for evaluation of skin diseases are lacking.

We attempted to determine the percentage of encounters in which two different dermatologists, one using telemedicine and one on-site, could independently arrive at the same primary diagnosis.

Two clinical telemedicine sites linked through the Georgia Statewide Telemedicine 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 examination room and evaluated them on-site. Each investigator recorded their diagnoses with no discussion with each other. As a control group, the investigators independently and in a blinded fashion (to each other's diagnoses) recorded diagnoses for a group of patients from a third dermatologist's clinic. Raw data were evaluated and classified by this third dermatologist who assigned diagnoses to categories of complete agreement, partial agreement, or disagreement.

There were no significant differences with regard to disagreement. However, there was a higher probability of complete agreement between the two dermatologists when each examined the patient on-site and in person than when one evaluated the patient on telemedicine and one examined the patient on-site and in person.

Our results suggest that telemedicine is an effective means of diagnosing cutaneous diseases. However, because 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 necessary to increase the likelihood of complete agreement on diagnoses among dermatologists using interactive television.