By: Adam Khan, MS3 and Timothy Aungst, PharmD
Title: Teledermatology: The Use of Ubiquitous Technology to Redefine Traditional Medical Instruction, Collaboration, and Consultation
Authors: Richard Brand PA-C, MPAS; David Hensley, MD, FAAD
Journal Published: The Journal of Clinic and Aesthetic Dermatology
Date Published: November 2012
Brand R, Hensley D. Teledermatology: The Use of Ubiqutous Technology to Redefine Traditional Medical Instruction, Collaboration, and Consultation. J Clin Aesthet Dermatol. 2012 Nov; 5(11):35-7.
Dermatology, reliance on visual examination is a field ripe to benefit from mobile technology. This concept, termed Teledermatology – referring to (1) either capturing digital still photos and forwarding them to dermatologists later; or (2) capturing real-time audio and video to transmit live communication – has become a popular research topic for this reason. And the research is favorable; reviews cite teleradiologist diagnostic agreement on par with that of clinical dermatologists. 
This study attempts to add to the literature by assessing the use of already widespread technology, not specialized equipment, in a dermatology practice. As cited by the authors, in a Manhattan Research study, “seventy-five percent of physicians own some form of Apple device.”  Hence, the authors attempted to examine the reliability of Apple’s Facetime® video-streaming product as the medium for teledermatology consultation.
The endpoints of the study were to assess the concordance in diagnosis between a junior health provider and senior consulting dermatologist using the Apple products: iPod Touch 4 and iPad 2.
- A 20-patient trial of willing participants.
- Half (10 patients) were presented by the physician assistant using an Apple iPad 2 and sent to a consulting dermatologist on his Apple iPod Touch 4 via Facetime®
- Half (10 patients) were presented by the physician assistant using an Apple iPad 2 and sent to a consulting dermatologist on his Apple iPad 2 via Facetime®
- Diagnostic impressions were recorded; no statistical analyses were performed.
- The agreement between the physician assistant’s preliminary diagnosis and the dermatologist was positive in 80% of cases (n=16).
- 7 out of 10 cases in arm 1 (transmitting data to an iPod Touch 4)
- 9 out of 10 cases in arm 2 (transmitting data to an iPad 2)
- Dermatologists noted easier viewing, better illumination, and more clarity with the iPad 2 than the iPod Touch 4
The agreement in 80% of cases was consistent with literature review based on earlier teledermatology studies.  This high concordance supports the use of ubiquitous technology to remove barriers experienced by some clinicians to engage in teledermatology consultants with colleagues.
Commentary & Implication to mHealth
As a study assessing the use of already ubiquitous technology, the authors selected the right devices. The Apple iPad and iPod/iPhone devices can be found in the lab coats of clinicians throughout the country, making the design and implications for dermatologists more relatable.
However, as a study meant to demonstrate evidence to support use in a clinical practice, this article is lacking:
- The exact methodology as to how video was recorded is not addressed, whether there was any standardized protocol to account for video capturing as lighting and environment may affect the quality of video transmitted.
- Additionally, a larger patient trial with a more standardized regimen would be required before drawing any statistically significant conclusions from this paper.
The paper is a good step in the right direction. The iPad has already gained traction as a teaching tool in medicine. However before making recommendations for its use in teledermatology consults, larger studies with more sophisticated analyses must be performed.
1. Levin YS Warshaw EM. Teledermatology: a review of reliability and accuracy of diagnosis and management . Dermatol Clin. 2009 Apr; 27(2): 163-76, vii
2. Manhattan Research. 75 Percent of U.S. Physicians Own Some Form of Apple Device According to New Manhattan Research Study. New York; 2011. http://manhattanresearch.com/News-and-Events/Press-Releases/physician-iphone-ipad adoption.
3. Eedy DJ, Wootton R. Teledermatology: a review. Br J Dermatol.2001;144(4):696–707.