Abstract
BackgroundPhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)–based mobile devices.ObjectiveThe aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes.MethodsRetrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant).ResultsDuring the study period, there were 1139 photo sessions on 1059 unique patients. Of the 1139 sessions, 395 (34.68%) sessions documented dermatologist input in the EHR via dermatology curbside consultation, eConsult, and in-person dermatology consult. Clinicians utilized curbside phone consults preferentially over eConsults for TD. By clinician type, nurse practitioners (NPs) and physician assistants (PAs) were more likely to utilize the PhotoExam for TD as compared with physicians. By specialty type, pediatric clinicians were more likely to utilize the PhotoExam for TD as compared with family medicine and internal medicine clinicians. A total of 108 (9.5%) photo sessions had a biopsy performed of the photographed site. Of these, 46 biopsies (42.6%) were performed by a primary care clinician, and 27 (25.0%) biopsies were interpreted as a malignancy. Of the 27 biopsies that revealed malignant findings, 6 (22%) had a TD consultation before biopsy, and 10 (37%) of these biopsies were obtained by primary care clinicians.ConclusionsClinicians primarily used the PhotoExam for non-TD purposes. Nurse practitioners and PAs utilized the app for TD purposes more than physicians. Primary care clinicians requested curbside dermatology consults more frequently than dermatology eConsults.
Highlights
The visual nature of skin conditions in dermatology has promoted the application of medical photography in the specialty
Nurse practitioners and physician assistants (PAs) utilized the app for TD purposes more than physicians
For eConsults, we looked for statements from the responding dermatologist about the quality of the photographic images, noting if the dermatologist made any comment on inadequacy of images for any reason
Summary
The visual nature of skin conditions in dermatology has promoted the application of medical photography in the specialty. 1 (page number not for citation purposes) communication with the health care team and patients and documentation for medical and academic purposes [1]. Multiple applications of digital photography in dermatology have emerged, including education, clinical archiving in patient records, surgical documentation pre- and postoperatively, follow-up of chronic conditions for progression or treatment response, diagnosis of melanocytic lesions, and teledermatology (TD) consultation [1]. Three modes of TD care delivery are utilized: (1) store and forward (S&F) for transmitting digital images and clinical information to the dermatologist for consultation at a later time; (2) real-time video teleconferencing (VTC), where clinicians and patient interact live in videoconference; and (3) a hybrid model using a combination of the above. PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)–based mobile devices
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