Supplementary Material for: Does the diagnostic Accuracy and Rates of face-to-face visits occurring shortly after an asynchronized Tele-dermatology consultations justify its implementation: An 18-month Cohort Study

Introduction:
In 2019, Maccabi Health Services (MHS), rolled out the store-and-forward “Dermadetect” teledermatology consultation (TC) application. Study goal was to analyze MHS records of TCs (August 2019-February 2021) for the rate and reasons for face to face consultations (FTFC) occurring shortly after a TC with emphasis on FTFCs resulting in a different diagnosis for the same indication.
Methods:
The records of FTFCs held up shortly after TCs were reviewed and classified into cases marked as unsuited for tele-dermatology, cases which the indication differed and cases with the same indication which were analyzed for concordance of diagnoses.
Results:
Dermadetect was used by 12815 MHS beneficiaries. In 30% of cases, a following FTFC occurred within the subsequent 5 months and 901 of them occurred in the subsequent 2 weeks and were analyzed: Thirty percent were not suited for tele-dermatology, 15% were held for a different indication and 55% occurred for same indication. The diagnosis concordance between the TC and recurrent FTFC for the same indication was 97.4%, with full concordance at 68.1% and partial concordance at 29.3%.Overall, 13 patients (1.4%) of the 901 patients using the application only once had a subsequent FTFC within 2 weeks and received a different diagnosis than the one given in the TC.
Conclusions:
When considering the implementation of store and forward TC's, a 30% rate of a following FTFC's during the next 5 months should be considered when planning the reimbursement model. Diagnosis discordance may be disregarded due its low rates.