000130024 001__ 130024
000130024 005__ 20240130142254.0
000130024 0247_ $$2doi$$a10.1016/j.ijmedinf.2012.02.008
000130024 0248_ $$2sideral$$a76585
000130024 037__ $$aART-2012-76585
000130024 041__ $$aeng
000130024 100__ $$aLasierra, N.$$uUniversidad de Zaragoza
000130024 245__ $$aLessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations
000130024 260__ $$c2012
000130024 5060_ $$aAccess copy available to the general public$$fUnrestricted
000130024 5203_ $$aPurpose
This paper presents a three-year teledermatology evaluation experience. The aim is to explain the methodology followed, present the evaluation results, discuss critically the issues that emerged during the experience and report the main lessons learned.
Methods
A complete design and evaluation methodology was conducted to fully address significant issues arising from other previous teledermatology experiences. First, system-design requirements and image quality issues were studied. Then, a detailed clinical concordance study was undertaken to determine the accuracy of diagnoses made using teledermatology in order to assess different dermatological clinics. Finally, an impact study on the health system was performed. Furthermore, clinical, technical, social and alignment outcomes were analyzed during the study and at the end of it, in order to understand how emerging factors affected the final setup of the teledermatology system.
Results
The most important results reported in this study can be summarized as follows. (1) A complete web-based environment for teledermatology support was developed as a result of a dynamic evaluation process with clinical personnel. (2) A total of 120 teleconsultations (82 pediatric and 28 adult) were made during the clinical concordance study. Concordance analysis was carried out for each dermatological disease group. High concordance rates were found in pediatrics for inflammatory dermatoses (76%) and also for adults (75%) with infections and infestations. (3) Physicians were satisfied with the teledermatology system but the time dedicated to consultation in primary care was a limiting factor (19 min for each teleconsultation). (4) An extensive discussion about the successful and the limiting aspects of the teledermatology experience revealed the reasons behind the final decision not to proceed with its implementation. It was considered not to be aligned with Health Care Organization (HCO) strategy and consequently did not achieve high-level support for its long-term implementation.
Conclusions
A high degree of diagnostic accuracy both for pediatric and adult consultations was achieved using the teledermatology system with affordable technical requirements. Its usefulness for filtering dermatological referrals was also demonstrated in the study. Nevertheless, other factors such as the reorganization required for the physicians’ time schedule, remuneration issues, absence of EHR (electronic health record) integration and lack of interaction with the HCO were important limiting factors. This led to the conclusion that under the evaluation conditions long-term set-up was not possible. It was also concluded that HCO participation would have been essential for both the evaluation study and the long-term set-up of the system.
Highlights
This paper reports a realistic experience in the design and evaluation of a telemedicine solution for remote dermatology consultation (tele-dermatology) in Aragón, Spain. ► This study takes a different approach discussing the strengths and limitations of a teledermatology experience in a realistic manner. ► A list of lessons learned is provided for future teledermatology implementations. Many pediatricians are involved in the experience providing in this way a detailed concordance analysis for children dermatological clinics.
000130024 536__ $$9info:eu-repo/grantAgreement/ES/MICINN/TIN2008-00933-TSI$$9info:eu-repo/grantAgreement/ES/MICINN/TIN2011-23792-TSI
000130024 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/
000130024 590__ $$a2.061$$b2012
000130024 591__ $$aCOMPUTER SCIENCE, INFORMATION SYSTEMS$$b18 / 132 = 0.136$$c2012$$dQ1$$eT1
000130024 591__ $$aMEDICAL INFORMATICS$$b7 / 21 = 0.333$$c2012$$dQ2$$eT2
000130024 591__ $$aHEALTH CARE SCIENCES & SERVICES$$b30 / 83 = 0.361$$c2012$$dQ2$$eT2
000130024 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/acceptedVersion
000130024 700__ $$0(orcid)0000-0002-5254-1402$$aAlesanco, A.$$uUniversidad de Zaragoza
000130024 700__ $$0(orcid)0000-0001-8034-3617$$aGilaberte, Y.
000130024 700__ $$0(orcid)0000-0002-5494-6550$$aMagallón, R.$$uUniversidad de Zaragoza
000130024 700__ $$0(orcid)0000-0001-9485-7678$$aGarcía, J.$$uUniversidad de Zaragoza
000130024 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000130024 7102_ $$15008$$2560$$aUniversidad de Zaragoza$$bDpto. Ingeniería Electrón.Com.$$cÁrea Ingeniería Telemática
000130024 773__ $$g81, 5 (2012), 332-343$$pInt. J. Med. Inform.$$tINTERNATIONAL JOURNAL OF MEDICAL INFORMATICS$$x1386-5056
000130024 8564_ $$s683634$$uhttps://zaguan.unizar.es/record/130024/files/texto_completo.pdf$$yPostprint
000130024 8564_ $$s1899266$$uhttps://zaguan.unizar.es/record/130024/files/texto_completo.jpg?subformat=icon$$xicon$$yPostprint
000130024 909CO $$ooai:zaguan.unizar.es:130024$$particulos$$pdriver
000130024 951__ $$a2024-01-30-14:19:35
000130024 980__ $$aARTICLE