February 1997

The Substitution of Digital Images for Dermatologic Physical Examination

Author Affiliations

From the Department of Dermatology, Harvard Medical School, Massachusetts General Hospital (Drs Kvedar, Edwards, Mofid, Gonzalez, and Parrish and Mr Menn), and New England Deaconness Hospital (Dr Dover), Boston, Mass.

Arch Dermatol. 1997;133(2):161-167. doi:10.1001/archderm.1997.03890380031005

Objective:  To investigate the diagnostic accuracy of clinicians viewing a patient's history and static digital image set compared with clinicians who conducted officebased physical examinations of the same patients.

Design:  Observational study.

Setting and Patients:  One hundred sixteen adult patients presenting with dermatologic symptoms in a university-based practice who consented to have their skin conditions documented with a still digital camera according to a standardized protocol.

Main Outcome Measures:  Concordance between office-based dermatologists' diagnoses and 2 remote clinicians' diagnoses using still digital images (resolution, 92 dots per inch) and identical medical history data to render diagnoses.

Results:  When photographic quality was high and office-based clinician certainty was high, remote clinicians were in agreement more than 75% of the time. Office-based and remote clinicians were in agreement 61% to 64% of the time for all cases. No specific disease category appeared to be more or less amenable to diagnosis based on still digital imagery. The diagnostic certainty of the office-based clinician (reported from 0-10) had the most impact on agreement. When cases with office-based clinician certainty of no more than 7 were compared with cases with certainty of at least 9, agreement increased 54% for remote clinician 1 and 111% for remote clinician 2. As an isolated variable, photographic quality had a modest impact on agreement.

Conclusions:  Still digital images can substitute for the dermatologic physical examination in up to 83% of cases. This study provides validation of the store-and-forward concept of telemedicine as applied to dermatology. These results serve as the foundation for field testing of the concept in primary care settings.Arch Dermatol. 1997;133:161-167