JMIR Publications

ABSTRACT

Background:

Telemedicine is defined as the use of electronic information and communication technologies to provide healthcare to the patients by healthcare professionals. Although available since the pre COVID-19 era, a huge surge in teledermatology consultations occurred during COVID-19 outbreak. As access to healthcare became limited and difficult due to repeated lockdowns, teledermatology helped us provide healthcare to our patients. More so as Dermatology is a visual subject, it was even more suitable for teleconsultations.

Objective:

The objectives of the study were to know the advantages, shortcomings and challenges of teledermatology in India both during and post COVID-19 outbreak.

Methods:

This was a single center retrospective observational study conducted at a tertiary care hospital in India. Teledermatology consultation data starting from 1st April 2020 till September 2021 (18 months) was included. All modes i.e. real time (RT) video consultation, asynchronous store and forward (SAF) and hybrid were used to conduct teledermatology services. Statistical calculations were done using SPSS software.

Results:

During these 18 months, a total of 4280 patients took teledermatology consultations at our center. The mean age of patients was 34.19 years with most of them in the age group- 31-40 years(36.4%). It was a mix of urban (55%) and rural (45%) population. Diagnosis was established in 89.1% of the cases and the most common diagnosis was superficial fungal infections (28%) followed by eczema (16%) and acne (8.6%). Hospital visits were required in the remaining 10.9% for the following reasons: lack of clear pictures, technical errors (5.57%). Additional diagnostic tests were required in 1.3%, physical examination in 1.05% and 0.39% had life threatening conditions requiring hospitalization. Advantages of teledermatology are: decreased need of hospital visits by 89.1%, which played a very important role in decreasing overcrowding. Also it helps us provide expert healthcare to the rural population of the country. Shortcomings are lack of good quality pictures (4.2%), technical errors (1.37%), it can’t be used to manage life-threatening conditions (0.39%) and is more time consuming especially in RT video consultations (14%). Challenges faced by dermatologists during Teledermatology consultations were mainly operational like lack of good internet access leading to interrupted consults (1.37%), poor quality of pictures (4.2%), difficulty in extracting history in cases of SAF.

Conclusions:

Teledermatology serves as a triage platform and helps reduce hospital visits. It helps to cater the rural population who otherwise have limited access to healthcare. Few technical challenges are the dependance of teledermatology on pictures and information sent by the patient for establishing the diagnosis. Also sometimes patients faced difficulty in conveying problems clearly to the doctors. Because of the ease and advantages, several dermatologists have continued to use teledermatology along with the physical consultations post COVID. Definitely with a few advancements, teledermatology will remain a successful and useful model for consultations more so for catering the population with lack of access to specialist services. Clinical Trial: Tel