Background: Access to pediatric subspecialty care is often challenging outside of large urban areas, especially in the field of pediatric dermatology. Overall, demand for pediatric dermatologic care outstrips the supply of pediatric dermatologists. As a result, the need for dermatology consultative services to hospitalized children is increasingly unmet. Teledermatology, or the use of telemedicine platforms to provide dermatology consultation, has emerged as a solution to bridge this gap. Even with parent-submitted photographs, teledermatology has been found to be accurate, both with consumer mobile phone photographic applications and dedicated mobile health photographic applications. Concerns remain, however, whether teledermatology consultation in the inpatient setting is timely enough to be useful in caring for hospitalized children.
Purpose: To assess the feasibility and utility of a teledermatology consultative service in the setting of an inpatient pediatric unit of an academic medical center
Description: In early 2017, the Dermatology Program of Boston Children’s Hospital (BCH) began to work with Boston Children’s Innovation/Digital Health Accelerator to identify a telemedicine platform to provide remote dermatology consultation to Baystate Children’s Hospital. After considering the cost, quality, and usablity of multiple platforms, the 3Derm teledermatology platform (Digital Diagnostics, Inc., Coralville, IA) was selected. Extensive discussions with BCH dermatologists and 3Derm representatives led to development of a teledermatology workflow (Figure 1). This was approved by BCH dermatologists and the Chair of Pediatrics at Baystate. Teledermatology consults would be “store-and-forward,” utilizing the secure, HIPAA compliant 3Derm hardware and web-based platform. Images taken at Baystate would be viewed by a BCH attending dermatologist utilizing a VR headset. Coverage would be 24/7, but non-emergent only. An escalation process for emergent consults that would likely require transfer to BCH was established. A 6-week implementation plan involving workflow and hardware/software provider education, onsite training, and mock visits was undertaken. BCH dermatologists acquired telemedicine privileges at Baystate, and 3Derm representatives worked with both IT departments to develop a flow of consult documentation directly into Baystate’s electronic medical record (EMR). Use of the 3Derm imaging hardware and software was limited to pediatric hospitalist attendings, who cover an inpatient pediatric unit and a well newborn nursery. Over a 13-month period, 34 consults were sent to BCH dermatologists, of which 85.3% were technically successful. Of these consults, 90% led to changes in inpatient management. The mean time from a consult being submitted to being received back at Baystate was 77.4 minutes. (Table 1)
Conclusions: Pediatric teledermatology consultation provided in the inpatient setting is technically feasible, timely, and impactful in the care of hospitalized children.
