Telemedicine in the Apple App Store: An Exploratory Study of Teledermatology Apps

Background: ‘Direct to Consumer’ (DTC) mobile teledermatology apps are becoming available enabling patients to communicate directly with specialists without going through primary care providers or other trained intermediaries. Introduction: An exploratory study was done to determine app diagnostic quality and features that help or hinder patients' ability to communicate with diagnosticians. Materials and Methods: All mobile teledermatology apps available at the Apple App Store were reviewed, the two most popular were identified and tested together with three other apps having similar functionality using a single patient who was also examined by a dermatologist in-person. Results: Apps varied in diagnostic scope, data gathering methods, services, rendered results, and in geographic coverage and cost. Discussion: Apps were weak in thoroughness of taking diagnostic history, omitting key questions related to current medications and allergies. The dermatology practices associated with different apps tended to provide concordant diagnoses, except for one using the app that was least thorough. Conclusions: Mobile teledermatology apps vary and can potentially affect continuity of care. Since some may increase risk of medical errors the American Telemedicine Association's guidelines for teledermatology need to address the use of direct to consumer apps. App regulation, certification, or guidelines suggesting appropriate development and use are needed. These conclusions are reinforced in a larger study that since has been conducted.