32849 Quality and utility of patient-initiated store-and-forward teledermatology images

Abstract

Store-and-forward (SAF) teledermatology uses images for medical decision-making asynchronous to a patient encounter. The quality and utility of these images may vary depending on whether photographs are taken by trained clinicians or patients themselves. Recently, our institution enabled a functionality in the online health application MyChart for patients to attach images to messages sent to their care teams. This new feature led to an influx of photographs to our Department of Dermatology, many of which were unsolicited. Given the dearth of research on patient-initiated SAF images, we analyzed photographs attached to MyChart messages to our department from 8/01/2018 to 12/31/2019. Six attending dermatologists and 4 dermatology residents reviewed images based on their quality and clinical utility. Each image was evaluated by three reviewers through survey questions. In preliminary analyses of 400 images, reviewers indicated they would feel comfortable with making a medical decision based on the provided image on average 59.1% of the time, and images were of sufficient quality to include in the electronic health record 62.7% of the time. When we examined components of their quality, images were on average appropriately distanced 70.2% of the time, sufficiently lit 61.3% of the time, and in focus 58.7% of the time. Images depicted inflammatory skin conditions in 51.5% of responses, and interrater agreement (kappa) of diagnostic category ranged 0.33 to 0.52. Our results show that a substantial number of patient-submitted images are of low quality and utility, which may delay clinical workflow without benefit to patient care.