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• W1973200311 abstract "Although two papers published in this issue provide us with additional information about the current state of teledermatology services, we probably remain some way off a final evaluation of the current role of this technology in the provision of dermatology services in the NHS. Over the past decade many clinicians in the U.K. have expressed concerns over the development of teledermatology and this was probably reflected by the fact that the Action on Dermatology in 2001 had only three pilot sites out of 15 devoted to looking at teledermatology as a way of improving access for patients to secondary care. One of these never started and the status of the other two is unknown. It was thought by the Department of Health and Government policy advisers that the use of digital photography and improvements in electronic communications such as store-and-forward technology would provide a potential panacea for specialties like dermatology in an effort to decrease outpatient waiting times. The reason for this seems simple: the images obtained from digital photography are of such high quality that why couldn't images of skin conditions be e-mailed to a dermatologist and save the patient a hospital visit? This would reduce costs and decrease waiting times, but clinical effectiveness and cost-effectiveness of such services remain largely untested. If only dermatology were that simple! In an article on palpation of the skin, Dr Cox recently summarized some of the reasons, obvious to dermatologists, why this approach is simplistic.1 They include the fact that it is often necessary to palpate the skin in order to help make the diagnosis, one cannot judge the patient's concerns and anxieties just from a series of digital images, other areas of pathology are missed that are not photographed and often the images are of poor quality, thus making a diagnosis difficult. In a recent NHS R&D Technology Assessment, patients referred to a 2-week wait clinic were invited to have a series of digital photographs, with and without dermoscopy, immediately before their face-to-face consultation.2 An unexpectedly high proportion (33%) of referrals proved to have a malignancy or a severely dysplastic lesion, with almost 22% having a malignant melanoma or squamous cell carcinoma, possibly reflecting the rise in incidence of skin cancers reported elsewhere. If the highest level of clinician confidence had been applied, no cancers would have been missed, but only 20% of patients would have avoided an outpatient appointment. It was concluded that it is unlikely that this approach can dramatically reduce the need for conventional clinical consultations while still maintaining clinical safety.2 The first paper in this issue is a literature review of teledermatology evaluation and research.3 The authors carried out a systematic review of the literature over the last 40 years and concluded that most of the studies published are feasibility studies rather than phase III or phase IV studies. They found that compared with other specialties in telemedicine, teledermatology seems to be a ‘mature application’. However, more research on clinical outcomes such as preventable referrals and time to recovery would be needed to prove that teledermatology is indeed a promising and cost-saving technology. The second paper reports qualitative research into teledermatology in the U.K. and is an extremely thorough study involving interviewing various stakeholders in teledermatology development within the NHS.4 One of the authors’ conclusions was that the original policy vision of how teledermatology would be used as a technological answer for long waiting lists and consultant shortages has failed to be realized. They also found that teledermatology services were initially viewed as a diagnostic service but then increasingly gained acknowledgement as a triage and management service. The successful implementation of teledermatology as a routine service requires understanding of and paying great attention to the interplay between social and technical aspects of teledermatology. This means it is not a quick, simple fix for dermatology. However, it is uncertain that the politicians and policy makers who lead developments in the Health Service will listen." @default.
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• W1973200311 date "2007-03-01" @default.
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• W1973200311 title "Has teledermatology in the U.K. finally failed?" @default.
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• W1973200311 doi "https://doi.org/10.1111/j.1365-2133.2007.07750.x" @default.
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