Impact of Live Interactive Teledermatology on Diagnosis, Disease Management, and Clinical Outcomes

Objective: To assess the impact of live interactive teledermatology consultations on changes in diagnosis, disease management, and clinical outcomes. Design: We conducted a retrospective analysis of 1500 patients evaluated via live interactive teledermatology between 2003 and 2005 at the University of California, Davis. We compared diagnoses and treatment plans between the referring physicians and the teledermatologists. Patients with 2 or more teledermatology visits within a 1-year period were assessed for changes in clinical outcomes. Setting: Academic medical center with an established teledermatology program since 1996. Participants: Medical records were evaluated for 1500 patients who underwent live interactive teledermatology consultation. Patients seen for more than 1 teledermatology visit were included in the clinical outcome assessment. Intervention: Live interactive teledermatology consultation. Main Outcome Measures: Changes in diagnosis, disease management, and clinical outcome. Results: Compared with diagnoses and treatment plans from referring physicians, the 1500 live interactive teledermatology consultations resulted in changes in diagnosis in 69.9% of patients and changes in disease management in 97.7% of patients. Among 313 patients with at least 2 teledermatology visits within 1 year, clinical improvement was observed in 68.7% of patients. Multivariate analysis showed that changes in diagnosis (P=.01), changes in disease management (P <.001), and the number of teledermatology visits (P<.001) were significantly associated with improved clinical outcomes. Conclusions: Live interactive teledermatology consultations result in changes in diagnosis and disease management in most consultations. The numbers of live interactive teledermatology visits and changes in diagnosis and disease management are significantly associated with improved clinical outcomes.