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Store-and-forward teledermatology effective in public safety-net hospital system

Implementation of a store-and-forward teledermatology system in a large public safety-net health and hospital system improved access to dermatologic care, according to study results recently published in JAMA Dermatology.

Researchers sought to develop a store-and forward teledermatology workflow using the Epic electronic health record (EHR) software at Parkland Health and Hospital System, the safety-net public health system of Dallas County, Texas.

Two board-certified dermatologists independently evaluated electronic consults and gave diagnoses and treatment plans to PCPs. In-person referrals from the same community outpatient clinical were used to compare results.

Patients aged 18 years and older with dermatologic complaints who would otherwise have been referred to a dermatology clinic were included in the study.

Six PCPs from an outpatient clinic placed 79 teledermatology consults (74% female; mean patient age, 47 years) between May and December 2014.

Comparing in-person dermatology visits with teledermatology, median time to evaluation was reduced from 70 days (interquartile range [IQR] = 33.25-83 days) to 0.5 days (IQR = 0.172-0.94 days), while median time to treatment was reduced from 73.5 days to 3 days.

Eczematous conditions were the primary reason for teledermatology referrals, whereas benign tumors or proliferations were the primary reason for traditional referrals.

There were 120 out of 144 (83.3%) patients evaluated by a dermatologist through teledermatology or in -person during the study period compared with 111 of 173 patients (64.2%) in the prior year period.

Management recommendations were followed by PCPs 93% of the time.

“This study demonstrates the effectiveness of [store-and-forward] teledermatology built into Epic, the existing EHR in a large safety-net public hospital and health system through faster access to evaluation and treatment by a dermatologist,” the researchers concluded. “We also showed high fidelity of management and treatment recommendation made by teledermatology and carried out by PCPs. Because Epic is currently one of the most commonly used EHRs, there is potential to expand access to [store-and-forward] teledermatology at a national level.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.