Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform

Abstract

Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system.Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases.Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7–21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26–3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.

Médecins Sans Frontières' Clinical Guidance mobile application: analysis of a new electronic health tool

“…Finally, opportunities to collaborate with additional MSF-supported electronic health initiatives are promising, particularly MSF's existing telemedicine system. 11 Limitations of this study include the lack of variables retrieved on individual app downloads in terms of MSF affiliation and designation as a health care professional.…”

Teledermatology Use in Remote Areas of French Guiana: Experience From a Long-Running System

“…The feedback survey response rate of 38.8% remained low. The Médecins Sans Frontières telemedicine system, which has been operating for 7 years, has been regularly evaluated by feedback surveys from users with comparable rate around 30% (1,2).…”

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Store‐and‐forward teledermatology service for primary care providers in Afghanistan

“…Specialty care, including dermatology, is limited in Afghanistan. Telemedicine has expanded dermatology services in other resource‐limited settings . Herein, we offer the first summary of patient demographics and categories of dermatologic diseases referred for teledermatology consultation by primary care providers in Afghanistan.…”