Long-Range Diagnosis of and Support for Skin Conditions in Field Settings
Abstract
:1. Introduction
2. Types of Mobile Health (mHealth) and Telemedicine Tools
3. Benefits and Practical Applications of eHealth Tools
4. Challenges and Barriers to Use of Teledermatology
5. Practical Tips for Implementation of a New Teledermatology Initiative
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Platform Type | Advantages | Disadvantages | Examples |
---|---|---|---|
Formal Teledermatology Platforms | |||
Web and/or Mobile Teledermatology Applications | secure, guides referring providers through a dermatology consult, stores a record of all consults, most applications can be used on desktop or mobile device | must identify and register all users, must train all users, cost associated with creation of application or subscription to use, most time intensive for providers to utilize, difficult for providers to ask follow up questions, usually no mechanism for long term follow-up of cases, requires wifi or strong network signal | Africa Teledermatology Project [10], Swinfen Charitable Trust [11,12], MSF [13], ClickMedix [15], Azova [16] |
Informal Teledermatology Platforms | |||
Secure Email | can be used on desktop or mobile device, minimal training needed for users, minimally time intensive, fits into most providers daily routine, options for free access | security depends on email server, requires wifi or moderate network signal, no structure to guide consults, email accounts may have limited storage capacity, provider must identify and obtain emails of consultants to connect | free encrypted email services: Proton mail [17], Tutanota [18] |
Secure Cloud Based File Sharing | can be used on desktop or mobile device, options for free access, provides a mechanism for organized storage of patient information, minimally time intensive | limited storage on free versions, requires some training for users, users must register, requires wifi or strong network signal, moderately secure, no structure to guide consults | Dropbox [19], Google Drive [20], OneDrive [21], Box [22] |
Secure Direct Messaging Applications | fits into providers daily routine, least time intensive, minimal training needed, allows real time communication during patient visits, options for text/photos/videos/audio messaging, allows open communication for follow up questions and patient follow up, options for free access, secure end to end encryption, allows one-on-one or group chats, works well with low signal or wifi | provider must identify a consultant and obtain a phone number to connect, no structure to guide consults, no organized record of consults or communications | Free: WhatsApp [23,24], MedTunnel [25],Bloomtext [26] Paid: Imprivata [27], TigerConnect [28], Voalte [29], QliqSoft [30], Spok Mobile [31] |
Social Networking Sites | free, low time commitment, minimal training needed, allows connection to a single provider or a global network, any provider can register and connect, works well with low signal or wifi | cannot guarantee security, difficult to guarantee credentials and expertise of consultants providing advice, no structure to guide consults, no organized record of consults or communications | Telederm.org [32], Sermo [33], Facebook [34] |
Telepathology Platforms | |||
Virtual Slide Microscopy (VSM) | secure, highest quality images, can view any part of the slide at any magnification, creates an organized library of cases for teaching or research, least time intensive for reviewer when slides are pre-scanned | high cost to purchase, ongoing costs to maintain equipment and software, requires significant training, needs high storage capacity for images, needs consistent and high bandwidth to function, slide scanning can be time intensive for sender | Olympus VS 120 [35], Zeiss Axio Scan.Z1 [36], Leica Aperio AT2 [37] |
Dynamic Slide Microscopy (DSM) | secure, can view any part of the slide at any magnification, potentially lower cost to implement compared to VSM | highest bandwidth requirements which may limit image quality, requires strict program compatibility for viewing, requires significant training, ongoing costs to maintain equipment and software, most time intensive to use for sender and reviewer | Leica Aperio LV1 [38], 3dHistech Panoramic DESK II DW [39] |
Static Imaging | lowest cost, works with any microscope, no software requirements, does not require consistent wifi | risk of sampling error, quality of images varies based on skills of photographer, can only view areas of tissue and magnification chosen by photographer, time intensive for sender and reviewer | smartphone to eyepiece attachments: LabCam [40], Magnifi [41], Snapzoom [42]; any smartphone camera through eyepiece; any digital microscope camera |
Applications of Teledermatology | Benefits | Recommended Platforms for Remote Providers |
---|---|---|
Tele-Triage | appropriate and timely scheduling of patients into dermatology clinic, timely referral of dermatology patients to other specialists | secure direct messaging |
Primary Care to Dermatology Consultation | diagnostic and management support, building dermatology skills over time | secure direct messaging |
Specialist to Dermatology Consultation | diagnostic and management support, care coordination, building dermatology skills over time | secure direct messaging |
Dermatologist to Dermatologist Consultation | second opinion, subspecialty dermatologist consultation, super specialist consultation for rare diseases, decreases isolation and burnout | formal teledermatology application, secure email, secure direct messaging, cloud based file sharing |
Telepathology | expert analysis of skin biopsy specimens, improved diagnostic accuracy of skin disease, training of local pathologists | static images via smartphone or digital microscope camera |
Long Term Management | allows for provider to dermatologist follow up, allows patient to dermatologist follow up, improves patient compliance and patient outcomes | secure direct messaging, secure email, cloud based file sharing |
Care Coordination | allows for group chats between various providers to save time and resources | secure direct messaging, secure email, cloud based file sharing |
Dermatology Education | remote access to dermatology education in any setting, builds local capacity | web based learning modules, video lectures, virtual patient encounters, email or web based access to lectures/handouts/guidelines, clinical decision support tools |
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Williams, V.; Kovarik, C. Long-Range Diagnosis of and Support for Skin Conditions in Field Settings. Trop. Med. Infect. Dis. 2018, 3, 84. https://doi.org/10.3390/tropicalmed3030084
Williams V, Kovarik C. Long-Range Diagnosis of and Support for Skin Conditions in Field Settings. Tropical Medicine and Infectious Disease. 2018; 3(3):84. https://doi.org/10.3390/tropicalmed3030084
Chicago/Turabian StyleWilliams, Victoria, and Carrie Kovarik. 2018. "Long-Range Diagnosis of and Support for Skin Conditions in Field Settings" Tropical Medicine and Infectious Disease 3, no. 3: 84. https://doi.org/10.3390/tropicalmed3030084