Diagnostic Agreement Between Telemedicine on Social Networks and Teledermatology Centers

Sophia Serhrouchni; Alexandre Malmartel


Ann Fam Med. 2021;19(1):24-29. 

In This Article



Our study found an acceptable agreement between the diagnoses made using social networks (Twitter and MedPics) and those made by TDS. Agreement was improved when a dermatologist answered posted queries. In addition, compared with reference diagnoses established by an expert committee, the number of correct diagnoses made on Twitter and MedPics were similar to those made by TDS.

Strengths and Limitations

Our search did not find any other study evaluating the diagnostic agreement between telemedermatology on the 2 social networks and TDS. This study allowed us to analyze a sufficient number of images and the responses of 270 health professionals over 6 months to limit selection bias. The cases in this study corresponded to issues seen in family medicine practices, as they were obtained from data published by GPs on Twitter and MedPics. The expert committee made it possible to use reference diagnoses and compare them with the tele-expertise of TDS.

Our study had some limitations. It was a retrospective study involving physicians that we could not directly question so no follow-up of patients was possible. In particular, there was no direct follow-up or dermatological monitoring implemented for patients. However, in order to avoid a selection bias of the cases and to have real situations, we judged it was not necessary to modify this aspect. Also, there was no histological analysis carried out to make a definitive diagnosis. Since the diagnoses were classic pathologies in general practice, however, it did not seem ethically necessary to systematically perform biopsies for diagnoses that are often determined by clinical observations. The committee of experts was therefore a good option for providing reference diagnoses in this situation lacking the gold standard.[13]

Comparison With Existing Literature

The dermatological pathologies diagnosed in our study were consistent with other French outpatient studies, finding mycoses and eczema to be the most frequently observed dermatological conditions.[14–16] The diagnosis of these frequent conditions is often clinically determined in general practice which probably explains why the number of correct diagnoses on Twitter and MedPics, without dermatologist's answer, was close to that of teledermatologists. There were few skin lesions suspicious for cancer in our study. This may be due to GPs not wanting to take a risk with an opinion from a social network for these lesions, and these patients were probably directly referred to a dermatologist.

Some studies have investigated the agreement between diagnoses by a physician in-person and tele-expertise services, but they did not evaluate this for the general practice setting. A study conducted in France between emergency physicians and TDS found diagnostic agreement coefficients ranging from 0.6 to 1.0.[6] In another study, conducted in California, dermatological tele-expertise was used to investigate suspected skin cancers. It compared dermatologists' diagnoses with those of TDS, by sending images by smartphone or e-mail. The agreement coefficients were between 0.57 and 0.62, which is similar to our results.[7]

Implications for Practice

Our study provides information on the expertise of GPs diagnosing benign dermatological pathologies in primary care. GPs who are less familiar with dermatology seem to benefit from the experience of other GPs. However, the involvement of dermatologists as secondary care physicians seems essential in the case of more unusual pathologies or uncertain diagnosis as Eminović et al has also stated.[5]

Twitter and MedPics seem to be reliable telemedicine tools in the face of dermatological diagnostic challenges in general medicine and limited accessibility to dermatologists. However, from an ethical point of view, some constraints must be taken into account. Sharing medical data through communication technologies that support telemedicine requires attention to the conditions for hosting data in a way that can guarantee patient privacy. In 2011, the National Council of the French Medical Order (Conseil National de l'Ordre des Médecins) established recommendations for doctors using social networks. These mention that social media users must "know and implement confidentiality settings in order to control the disclosure of personal information." Therefore, obtaining the patient's consent is an essential preliminary step. It is not specified that this consent is mandatory on MedPics or Twitter, but it is required in another mobile app called Figure 1. Then, the anonymization of images must be implemented. The MedPics app integrates this step using a face recognition algorithm that automatically masks faces when images are uploaded. Elements that could provide information about the identity of patients (names, references, tattoos, etc) must also be removed. On Twitter, no faces or distinctive signs were present on the posted images, but there is no automatic procedure on this social network. Despite these precautions, some dermatological lesions could appear as a distinctive sign and compromise patient privacy.

Regarding data security, MedPics states that images are stored on a secured server, while publication on Twitter is public. It is possible for a user to restrict the access to his messages by keeping his account private, therefore the possibility of responses by other users is limited.

Finally, it should be noted that the information about profession on the physician's Twitter profile is not subject to verification, in contrast to MedPics. However, the National Council of the French Medical Order does allow the use of pseudonyms, which implies the same ethical conditions as when the identity is known and which must be declared to the Council.[17] In this context, dermatologists have reservations about the use of social networks, particularly concerning data protection, patients' and physicians' anonymity, and medical liability.[18]

In conclusion, the results of this study show that some social networks could provide good diagnoses for dermatological lesions in general practice. The establishment of dermatological tele-expertise using social networks with more dermatologists would be necessary to enhance the GP's quality of diagnosis. These exchanges between colleagues would lead to a collective elaboration of the diagnosis, which would also make it possible to improve the accuracy of diagnoses and limit errors.[19] In addition, the use of these communication networks could improve physicians' professional satisfaction[20] and contribute to their professional development.[21] It seems essential to organize and secure social networks in order to ensure the protection of health data in the area of tele-expertise. There is potential danger in the development of unofficial telemedicine due to potential risks of using non-secure networks or even using social networks as a teleconsultation service.[22] The use of social networks for mutual assistance between physicians has been investigated in other studies,[23] but larger projects would be necessary to do this more precisely. In view of the good agreement with TDS and the experts committee, it should be possible to extend telemedicine tools with secure social networks to other medical specialties, encouraging exchanges between different specialists and promoting the continuity of patient care within the scope of GP's competencies.