key: cord-0937236-oukbf9os authors: Cartron, Alexander M.; Rismiller, Kyle; Trinidad, John C. L. title: Store‐and‐forward Teledermatology in the era of COVID‐19: A Pilot Study date: 2020-05-27 journal: Dermatol Ther DOI: 10.1111/dth.13689 sha: fc45b8bedd68f4f3cd109ab0b006fb1bf6487201 doc_id: 937236 cord_uid: oukbf9os nan Keywords: teledermatology; store-and-forward; telemedicine; COVID-19; coronavirus; inpatient dermatology To the Editor: Coronavirus Disease 2019 (COVID-19) represents a global health crisis in which personal protective equipment (PPE) has become increasingly limited. Dermatologists are poised to think creatively and use technology, such as teledermatology, to innovate existing workflows and optimize dermatologic care. We conducted a pilot, retrospective cohort study to evaluate the utility of store-andforward teledermatology during the COVID-19 pandemic. We included patients seen by the inpatient dermatology consult service at the Ohio State University Wexner Medical Center from March 16, 2020 to March 20, 2020. We used a recently proposed algorithm for how hospital settings can initiate and use telemedicine consultative services during the COVID-19 pandemic ( Figure 1 ). An integrated platform of store-and-forward teledermatology consults within the electronic medical record (Epic, Madison, WI) was used with a secure smart phone application (Haiku or Canto; Epic, Madison WI). Team members utilized the Cisco WebEx virtual conference call system to conduct HIPAA-compliant discussions about patients. Clinical data were abstracted by a member of the dermatology consult service. 16 patients (9 women, 7 men) were evaluated using store-and-forward teledermatology services ( Table 1) . The most common consulting services were hematology and internal medicine (both 37.5%). In 43.8% of cases, the consulting service did not have an initial diagnosis for the patient. A median of 8 photos (IQR 3-17 photos) were provided for each patient. Half of photos were determined to be high quality, while half were moderate quality. At the consult date, nearly all patients had unknown COVID-19 status (93.8%) and only 25% of patients had a negative final COVID-19 diagnosis. Two physicians avoided unnecessary daily contact with 11 patients. 5 of these patients ultimately required in-person evaluation by dermatology team members, in which 3 punch biopsies and one shave biopsy were performed. In utilizing teledermatology, 20 pairs of gloves, 16 gowns, 10 N95 masks, and 4 surgical masks were conserved over the course of a single week. Our findings demonstrate store-and-forward teledermatology can reduce unnecessary inperson patient evaluation and management. Past reports of store-and-forward teledermatology use in clinic settings found as many as 71% of cases resulted in new diagnoses with treatment changes in 60% of patients. 1 In our study, 13/16 (81.3%) of electronic consultations resulted in new diagnoses, which informed treatment changes. Limiting in-person interactions is essential to mitigating transmission of novel coronavirus SARS-CoV-2, which can persist on surfaces for 72 hours 2 and be transmitted by asymptomatic individuals. 3 In addition, PPE is increasingly scarce and expensive, prompting the Journal of the American Medical Association to publish an editorial soliciting creative ideas. 4 Our findings suggest teledermatology may be used in inpatient settings during the COVID-19 pandemic to conserve precious resources. This article is protected by copyright. All rights reserved. Limitations of our study include the small sample size, lack of a control group, and retrospective nature of the study. Our study also lacked metrics to evaluate the effect of inpatient teledermatology on quality of patient care and resident education. Nonetheless, we believe our data suggest the need for greater investigation of this issue and validation of our results with larger studies under normal circumstances. This article is protected by copyright. All rights reserved. Case appropriate for telemedicine? Staff with attending remotely or during rounds. • Preround with photos. • Limit number of people in room to limit PPE use (resident OR attending OK). • Appropriate universal precautions. • If biopsy necessary: BOTH resident and attending biopsy together. • Preround with photos. • One Resident and/or One Attending when rounding inperson. • Don appropriate PPE. • If biopsy necessary: BOTH resident and attending biopsy together. Store-and-forward teledermatology improves care and reduces dermatology referrals from walk-in clinics: A retrospective descriptive study This article is protected by copyright. All rights reserved The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany Conserving Supply of Personal Protective Equipment-A Call for Ideas This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.