Informatics
Teledermatopathology
General

Senior Author: Dariusz Borys, M.D.
Editor-in-Chief: Debra Zynger, M.D.

Topic Completed: 26 December 2018

Revised: 21 January 2019

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Informatics teledermatopathology
Page views in 2018: 64
Page views in 2019 to date: 76
Cite this page: Saleh J, Borys D. Teledermatopathology - General. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/informaticsteledermgen.html. Accessed May 22nd, 2019.
Definition / general
  • Digital transfer of image rich dermatopathology data using telecommunication technology
  • Classified into real time, store and forward or hybrid
Essential features
Terminology
  • Interchangeable terms may include digital pathology, digital microscopy, teleconference, teleconsultation, virtual microscopy and whole slide imaging (J Pathol Inform 2010;1:15)
  • Virtual slide system: an automated scanner that digitizes microscopic slides into high resolution images
  • Mobile teledermatopathology: the use of a smartphone or tablet to retrieve image rich slides from digital server
  • Real time (dynamic): images are examined in real time, using a live telecommunications link (J Pathol Inform. 2010 Aug 10;1. pii: 15)
    • Utilizes a remote controlled microscope and video conferencing equipment
    • Space independent but not time independent (Curr Dermatol Rep 2016;5:96)
      • Both parties must be available at the same time
      • May interrupt the routine workflow and make scheduling challenging
  • Store and forward (static): referring providers transmit the digitalized images to consulting pathologists by email or web based uploading systems (Curr Dermatol Rep 2016;5:96)
    • Uses a microscopy camera or automated scanner
    • Space and time independent (Curr Dermatol Rep 2016;5:96)
      • Does not require simultaneous presence of both parties
    • Compared to real time interactive, store and forward (Curr Dermatol Rep 2016;5:96, J Pathol Inform 2010;1:15):
      • Creates flexibility
      • Shorter consultation time
      • Less expensive
      • Higher resolution digital images
      • No or minimal interaction
      • Delayed responses
      • Consulting pathologist has no remote control of precaptured images and have limited fields of view to examine
    • Most commonly used modality of teledermatopathology (Curr Dermatol Rep 2016;5:96)
    • Major applications include Alaska Federal Health Care Access Network, Medweb, TeleDerm Solutions and Second Opinion (Curr Dermatol Rep 2016;5:96)
Diagrams / tables

Images hosted on PathOut server:

Contributed by Jasmine Saleh, M.D.

Real time

Store and forward

Applications
  • Communication with dermatologists and dermatopathologists in remote locations
  • Consultations for rural and underserved areas lacking access of specialists
  • Consultations for second opinions
  • Educational resources
  • Utilization of image analysis software and computer aided diagnostic tools to enhance diagnostic accuracy
  • Collaborative diagnostic research, tumor boards and scholastic endeavors
  • Real time (BMC Res Notes 2014;7:588):
    • Enables direct interaction between medical providers and pathologists
    • Facilitates education for providers
    • Allows for instant clarification of any issues that may arise
  • Store and forward (BMC Res Notes 2014;7:588):
    • Useful when physicians and pathologists have difficulty coordinating for in person or real time consultation
    • Beneficial for low resourceful settings
Advantages of teledermatopathology
  • Improves access to specialists as the number of dermatopathologists is limited and unevenly distributed geographically
  • Enhances quality of care and efficiency of workflow
  • Reduces interpretive errors and optimizes patient outcomes
  • Minimizes healthcare expenditures
  • Facilitates international collaboration
  • Prevents service disruption or loss
  • Reduces the pathologists’ travel time
Potential limitations
  • Quality of images (Am J Dermatopathol 2018;40:667)
    • Diagnostic reliability is comparable with conventional microscopes
      • Concordance rates 73 - 100%
    • Most studies conclude that the image quality is adequate for microscopic examination of melanocytic and inflammatory skin diseases
    • May be more difficult to identify eosinophils, neutrophils, melanin granules and apoptosis, as well as to grade melanocytic dysplasia
    • Images may be out of focus and require rescan
  • Possible technical issues (J Pathol Inform 2010;1:15)
    • Networks with bandwidth limitations
    • Firewalls that may block signals for remote device controls
    • Computer or scanner malfunction
    • Image deficiencies
      • Corrupted images
      • Images with poor resolution
  • Potential technical delays (J Pathol Inform 2010;1:15)
    • Waiting for images to download
    • Pixelating images when zooming
    • Slow internet connection
  • Obstacles to implementation (Am J Dermatopathol 2018;40:667)
    • Varying state licensing laws
    • Varying reimbursements by insurance provider and state
    • Regulatory issues with FDA
Implementation
  • Evaluation criteria before implementing teledermatopathology (including but not limited to) (Telemed J E Health 2010;16:424):
    • Technical resources required
    • HIPAA compliance with secure storage, transmission and access
    • Ability to store and transmit digit images, clinical history and consultant's diagnosis and recommendations in an organized fashion
    • User friendliness and intuitiveness of the application
    • Integration with existing EMR systems
    • Scalability and ability to fit into organization
    • Billing
    • Cost of equipment
  • Steps to incorporate teledermatopathology into practice (Semin Cutan Med Surg 2002;21:179):
    • Understand how the organization delivers care
    • Analyze the alternatives (i.e. cost benefit analysis)
    • Obtain organizational support
    • Formulate an execution plan
    • Train staff
    • Monitor the process and analyze outcomes (i.e. turnaround times)
  • Steps to implement teledermatopathology:
Obstacles to implementation
Board review question #1
    Which of the following is true about teledermatopathology?

  1. Does not increase access to specialists
  2. Has a poor diagnostic concordance
  3. Facilitates international collaboration and widens global access to specialists
  4. Increases interpretive errors
Board review answer #1
C. Teledermatopathology facilitates international collaboration and widens global access to specialists

Comment Here
Board review question #2
    Which of the following is the most commonly used modality in teledermatopathology?

  1. Store and forward
  2. Real time
  3. Hybrid
Board review answer #2
A. Store and forward

Comment Here
Board review question #3
    A dermatologist sends the patient’s clinical history and microscopic images of her dermatologic condition to a pathologist, who subsequently views them and provides diagnosis and recommendations. Which of the following modality did these physicians use?

  1. Hybrid
  2. In person consultation
  3. Real time
  4. Store and forward
Board review answer #3
D. Store and forward

Comment Here
Board review question #4
    A dermatologist emails a pathologist with the patient’s clinical history and microscopic images of her dermatologic condition. The pathologist reviews the information and responds to the email with diagnosis and recommendations. He also sets up a video consultation with the dermatologist. Which of the following modality did these physicians use?

  1. Hybrid
  2. In person consultation
  3. Real time
  4. Store and forward
Board review answer #4
A. Hybrid

Comment Here
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