The challenges of following patients and assessing outcomes in teledermatology.

We retrospectively reviewed the follow-up and outcomes of 50 store-and-forward teledermatology patients, and compared the findings with those from a control group of 50 patients who had been seen in person. Patient records were examined for a six-month period following the initial referral to a dermatologist. Variables examined included medical records from the referral, evidence of actions taken (e.g. biopsy), evidence of follow-up visits, and what (if any) clinical outcomes were noted. There were few differences between the teledermatology and in-person groups. The main difference was whether there was any report in the record that the referring clinician took some action based on the consultation with the specialist: there were more reports of action being taken in the teledermatology group than in the in-person group. Reports of outcomes were found in only 6% and 8% of the records of the teledermatology and in-person groups, respectively. The challenges of assessing outcomes in teledermatology for rural patients include patient loss to follow-up, lack of information in the patient records and low rates of patient return to the referring clinician for follow-up.