Smart phone as clinical tool: A teledermatology pilot program

A pilot project underway at several community health centers uses smart phones to increase access to a medical service in short supply in many parts of the country: dermatological care.

The American Academy of Dermatology and the University of Pennsylvania are collaborating on the project that is being tested in 10 cities in the United States and one in Canada.

Clinicians log their observations of patients’ skin ailments using a smart phone’s camera to take a photo of the affected area. They then transmit the information to the project’s Web site.

A dermatologist who has volunteered to work with a given clinic visits the site to review cases and provide his or her input. Clinicians are notified via their phones when a dermatologist submits a response, and the answer arrives as an attached message.

Clinicians at the participating health centers — free clinics, Federally Qualified Health Centers, and Medicaid-only clinics — have been trained on the smart phone system. The project covers locations in San Diego, Venice, Oakland and Sacramento, Calif.; southeastern Washington state; Missouri; Virginia; Philadelphia; Boston, and Vancouver.

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Dr. Carrie Kovarik, assistant professor of dermatology, dermatopathology and infectious diseases at the University of Pennsylvania, said the goal of the teledermatology project is to make specialized care more readily available to patients who do not have ready access to it.

“Even if they have some sort of medical care coverage, specialists are not realistically available for them,” she said. “The fact of the matter is, a lot of the patients with Medicaid wait 10 months to see a dermatologist."

The current pilot program stems from a proof-of-concept test last year that involved a handful of clinics in Philadelphia. That test equipped clinicians with a teledermatology application on a Samsung U900 phone. However, that didn’t prove user friendly. For example, the application handled the transmission of patient data and images as separate tasks, complicating the process for clinicians.

But the trial “showed us that this method of providing dermatology consultation was possible,” Kovarik said.

And the experience paved the way for the current platform, a Google Android G1 phone. Developed by ClickDiagnostics, the new application integrates the patient data and photo function for a more intuitive workflow. It also uses a touch screen; the earlier application was limited to keypad data entry.

“It has to be easy to use,” Kovarik said of the teledermatology application.

The project’s sponsors believe improved ease-of-use will help clinicians extend teledermatology services to more patients. Although the Philadelphia pilot project generated about 70 cases in six months — which Kovarik termed a good number of cases — she said she expects the new program to handle an exponentially higher number of cases.

In addition to usability, Kovarik said there are other considerations when developing and using smart phone applications. For example, she prefers camera phones with 5 megapixel resolution and auto-focus capability. Security and privacy are also concerns.

“We did institute full [Health Insurance Portability and Accountability Act] security for this app, and this, of course, is always an issue,” she said, adding that ClickDiagnostics undertook the compliance task.