Diagnostic Agreement Between Telemedicine on Social Networks and Teledermatology Centers

Sophia Serhrouchni; Alexandre Malmartel

Disclosures

Ann Fam Med. 2021;19(1):24-29. 

In This Article

Abstract and Introduction

Abstract

Purpose: With increasing delays in obtaining a dermatological consultation, general practitioners (GPs) are using social networks for telemedicine to obtain advice on dermatological images. The objective was to analyze diagnostic agreement between telemedicine on social networks (Twitter and MedPics) and standard teledermatology services (TDS).

Methods: This retrospective observational study included images published on Twitter and MedPics by GPs in 2016. The contextualized images were evaluated by 2 teledermatology services in Paris, France and an expert committee. Diagnoses obtained from telemedicine on social networks, TDS, and the expert committee were collected for each image. The agreement between the diagnoses made on social networks and by TDS was measured using Cohen κ statistic. The number of correct diagnoses obtained using social networks and TDS as determined by agreement with the expert's diagnoses were compared with χ 2 tests.

Results: Two hundred and seventy health professionals responded to the 60 selected images from social networks. The main diagnoses, according to the experts were: purpura (8.3%), eczema (6.7%), mycosis (6.7%), and viral infections (6.7%). Diagnostic agreement between telemedicine on social networks and TDS was moderate over the entire set of images (κ = 0.55; 95% CI, 0.42–0.68) and good for images containing dermatologist's answers (κ = 0.63; 95% CI, 0.45–0.85). The number of correct diagnoses was not statistically different between telemedicine on social networks and TDS on all images (60% vs 55%; P = .28) but was higher on social networks when a dermatologist answered (65% vs 55%; P <.01).

Conclusions: Diagnostic agreement using social network images showed that use of this telemedicine tool could be a reliable means to alleviate the difficulties of accessing dermatology consultations although data safety probably needs to be improved.

Introduction

Studies have shown that the dermatological diagnostic competence of general practitioners (GPs) is suboptimal, contributing to an increased use of dermatologists.[1] In fact, GPs feel insecure about their diagnostic abilities in dermatology, especially for cases of suspected malignant skin tumors.[1] In 2014, a review found that no tools or diagnostic aids for managing pigmented lesions were available to GPs.[2] Faced with increased delays (up to 2 months) for dermatologist consultations, the development and use of a photographic telemedicine tool could help minimize errors for patients managed in general practice.[3,4] Thus, for patients requiring a dermatology teleconsultation, a study found a decreased delay (4 days) in the teledermatology group, compared with 55.5 days in the control group. In addition, dermatologists estimated that 39% of dermatologist consultations were potentially avoidable, mainly because the patients recovered or the pathology was within the scope of general practice.[5]

Few studies have assessed the reliability of this process. They have reported moderate agreement between dermatological diagnoses made with teleconsultation and those made by consultating dermatologists or emergency physicians.[6,7] Teledermatology networks remain rare or relatively unknown in general practice despite the interest that primary care physicians have in telemedicine,[8] and the use of social networks has emerged as an alternative tele-expertise tool.[9] Actually, social networks are used by about 10% of health care professionals to share their experiences and questions. The impact of social network use on medical practices remains limited, however, partly due to concerns about the accuracy of answers obtained.[10] Health care applications based on sharing medical images such as MedPics, could address this issue because they use a secure network only accessible to identifiable health care professionals.

Social networks used as teledermatology services have not been studied for diagnostic quality and reliability of the messages published in tele-expertise consultation. We hypothesize that diagnoses using 2 social networks (Twitter and MedPics) used as a teledermatology tool are concordant with those of standard teledermatology services (TDS). The objective of this study was to assess the diagnostic agreement between telemedicine on social networks and TDS using images of dermatological issues published on Twitter and MedPics by GPs.

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