Development and Clinical Evaluation of an Artificial Intelligence Support Tool for Improving Telemedicine Photo Quality

Abstract

ImportanceTelemedicine use accelerated during the COVID-19 pandemic, and skin conditions were a common use case. However, many images submitted may be of insufficient quality for making a clinical determination.ObjectiveTo determine whether an artificial intelligence (AI) decision support tool, a machine learning algorithm, could improve the quality of images submitted for telemedicine by providing real-time feedback and explanations to patients.Design, Setting, and ParticipantsThis quality improvement study with an AI performance component and single-arm clinical pilot study component was conducted from March 2020 to October 2021. After training, the AI decision support tool was tested on 357 retrospectively collected telemedicine images from Stanford telemedicine from March 2020 to June 2021. Subsequently, a single-arm clinical pilot study was conducted to assess feasibility with 98 patients in the Stanford Department of Dermatology across 2 clinical sites from July 2021 to October 2021. For the clinical pilot study, inclusion criteria for patients included being adults (aged ≥18 years), presenting to clinic for a skin condition, and being able to photograph their own skin with a smartphone.InterventionsDuring the clinical pilot study, patients were given a handheld smartphone device with a machine learning algorithm interface loaded and were asked to take images of any lesions of concern. Patients were able to review and retake photos prior to submitting, so each submitted photo met the patient’s assumed standard of clinical acceptability. A machine learning algorithm then gave the patient feedback on whether the image was acceptable. If the image was rejected, the patient was provided a reason by the AI decision support tool and allowed to retake the photos.Main Outcomes and MeasuresThe main outcome of the retrospective image analysis was the receiver operator curve area under the curve (ROC-AUC). The main outcome of the clinical pilot study was the image quality difference between the baseline images and the images approved by AI decision support.ResultsOf the 98 patients included, the mean (SD) age was 49.8 (17.6) years, and 50 (51%) of the patients were male. On retrospective telemedicine images, the machine learning algorithm effectively identified poor-quality images (ROC-AUC of 0.78) and the reason for poor quality (blurry ROC-AUC of 0.84; lighting issues ROC-AUC of 0.70). The performance was consistent across age and sex. In the clinical pilot study, patient use of the machine learning algorithm was associated with improved image quality. An AI algorithm was associated with reduction in the number of patients with a poor-quality image by 68.0%.Conclusions and RelevanceIn this quality improvement study, patients use of the AI decision support with a machine learning algorithm was associated with improved quality of skin disease photographs submitted for telemedicine use.

JAMA Dermatology—The Year in Review, 2023

“…An important aspect of this model, and in part at the core of its significance, is that it can calculate hair loss due to different types of alopecia, distinct from current diseasespecific instruments used to rate alopecia severity. Vodrahalli et al 11 highlighted the capacity of a machine-learning algorithm trained on retrospective telemedicine images to identify poor-quality images and a clinical pilot study of a patient-facing application that was associated with a significantly reduced number of poor-quality images submitted by patients to their dermatologists. Cho et al 12 report the use of several AI modalities, including generative AI, to build comprehensive image datasets for dermatologic education.…”