>Tele-dermatology allows patients a long-distance diagnosis Emory dermatologist Marilynne McKay just turns on the television and picks up the telephone to diagnose suspicious-looking skin conditions in patients miles away at The Emory Clinic at South DeKalb.
Her access to the experimental AT&T Picasso Still-Image Phone System means that many Emory patients requiring a dermatology consultation may skip the trip to a specialist. They simply need to "hold still" while their primary care physician in South DeKalb uses a camera to capture still images of the spot in question and transmits the full-color images over phone lines to a specialist. The two physicians, probably miles apart, may simultaneously examine the skin lesion and discuss the case. They may either consult while the patient is present, or later, by calling up the stored, still images. The technology has been dubbed "tele-dermatology."
"The system is a time-saver and a resource-saver," said Thomas Carswell, a family physician at The Emory Clinic at South DeKalb. "The case of a man who visited our clinic with a skin rash illustrates just how useful this technology can be. While we were examining his rash, we noticed an odd lesion on the man's eyelid. We consulted with Dr. McKay via Picasso, and she made an immediate, preliminary diagnosis of eyelid skin cancer."
A biopsy confirmed the diagnosis, and the man is now being treated for cancer.
"The Picasso Phone System appears to be particularly suited for dermatologic consultation where visual images are an integral part of the diagnosis of skin diseases," wrote McKay and colleagues in a scientific paper on tele-dermatology presented earlier this year at the American Academy of Dermatology meeting in New Orleans.
"In addition to its obvious role in consultation and triage, the relatively low expense and portability of the Picasso System can permit field applications such as supervision of follow-up care of homebound patients with chronic lesions (e.g. leg ulcers) by physician extenders. Images can be stored for reference and teaching purposes, broadening applications beyond simple diagnostics."
The paper reported the results of a study in which four dermatologists were asked to diagnose various skin diseases in 38 patients using only still images from the Picasso System. The dermatologists did not verbally communicate with the referring physician, so they could not ask questions about the condition, nor were they given access to the patient's history. The diagnostic accuracy rate of the four doctors ranged from 63 percent to 88 percent.
Emory dermatology resident Joel F. Waltzer conducted another study of 30 patients in which dermatologists were allowed to view patient images and consult with each patient's primary care physician. The preliminary diagnosis accuracy rate was 87 percent.
The clinical evaluation of the Picasso Phone System at The Emory Clinic at South DeKalb is ongoing, said Jeffrey Dunbar, Emory Health Communications Project administrator. Applications for the system also are being evaluated by Emory specialists in emergency medicine, medical genetics, otolaryngology (ear, nose and throat) and ophthalmology.
--Lorri Preston