PORTSMOUTH, VA—Use of teledermatology has increased at military treatment facilities in response to greater demand for dermatologic care throughout military medicine and persistent, dermatologic provider shortages, according to a new study.
The article in Military Medicine noted that, while first used to aid in the differentiation of suspicious melanocytic lesions, dermoscopy, which functionally simulates a ×10 magnifying glass with the added feature of transillumination, has found increasing clinical utility in an expanding realm of general dermatologic conditions.1
In the report, Naval Medical Center Portsmouth-led researchers demonstrate the use of synchronous teledermoscopy within a remote MTF by repurposing webcam technology already available at most MTFs.
The authors described how two patients were seen in clinic at a remote naval primary care clinic with limited subspecialties. After written consent was retrieved, an on-site dermatologist evaluated each patient and performed a history and skin exam with dermoscopy. Synchronous consultations were conducted with the Global Med Cart (GlobalMed(R) Clinical Access Station with TotalExam(R) 3 HDUSB camera) and Cisco Jabber webcam video (Cisco TelePresence PrecisionHD USB Camera part number TTC8-03). The patients then underwent individual synchronous teledermatology consultations with an off-site Navy dermatologist in the continental United States.
“The methodology for the consultation involved the use of a standard dermatoscope and jabber webcam,” according to the report. “Two synchronous teledermatology consultations were completed successfully on patients in MTFs with limited subspecialty capabilities. Both cases, with two lesions of concern per case, had 100% concordance between the on-site and teleconsulted dermatologist. Through observing inter-rater agreements between the on-site and remote dermatologists, this small study demonstrates a novel application of technology readily available at most MTFs.”
Background information in the article described how cutaneous diseases are leading contributors to morbidity and decreased combat effectiveness of military servicemembers. The authors pointed out that a recent survey of deployed military personnel determined that dermatologic diagnoses accounted for 10% of total diagnoses during medical visits from 2007 to 2015.
Since 2004, according to the article, more than 400 teledermatology consultations have been performed per year, which is the highest of any single medical specialty in the military. It noted that the major goals of telemedicine are to:
- Decrease time to appointment for patients,
- Increase local quality of care,
- Decrease costs associated with medical evacuations,
- Minimize need for transportation to MTFs, and
- Increase readiness by limiting time away from work.
The authors explained that small studies have focused on the usefulness of teledermoscopy, with digital dermoscopic images transmitted over telecommunications networks. “We demonstrate the use of synchronous teledermoscopy within a remote MTF by repurposing webcam technology already available at most MTFs,” they added. “We present two synchronous telemedicine patient encounters where teledermoscopy use increased the diagnostic ability of the consulted dermatologist.”
- Day WG, Shrivastava V, Roman JW. Synchronous Teledermoscopy in Military Treatment Facilities, Military Medicine, , usz479, https://doi.org/10.1093/milmed/usz479