Creating a Web Infrastructure for the Support of Clinical Protocols and Clinical Management: An Example in Teledermatology.

Abstract

Introduction: We describe a teledermatology infrastructure, implemented as part of a statewide large-scale telemedicine network, designed to provide comprehensive support for examination and clinical management protocols, which includes telediagnostic and patient triage and referral. It was implemented as a web-based system and an associated mobile application that supports both the primary healthcare facility team and the specialist during the patient care process. Methods: We describe the process models, protocols and technology employed, and the requirements generated for their development. We also present the results and experiences gained in implementing the model. The teledermatology service was implemented in 313 primary healthcare facilities in 286 municipalities in the State of Santa Catarina, Brazil. This study covers the period from January 2014 to June, 2018. Results: During this period, the teledermatology infrastructure processed 83,100 teledermatology examinations, of which 75,832 were validated and employed for patient triage and clinical management. Teledermatology allowed 33,112 patients to avoid further referral and be treated locally. Of this cohort, 7,513 patients presented more complex dermatoses that could be treated at the primary care level using telehealth-supported clinical management. Conclusions: Results indicate that this model contributes not only to the resolution of cases at the primary care level but also to the progressive improvement of the technical quality of dermatological examinations performed by technical staff at the primary healthcare.