Mayo Clinic Proceedings: Digital Health (Mar 2024)

Differences Between Patient and Clinician-Taken Images: Implications for Virtual Care of Skin Conditions

  • Rajeev V. Rikhye, PhD,
  • Grace Eunhae Hong, BA,
  • Preeti Singh, MS,
  • Margaret Ann Smith, MBA,
  • Aaron Loh, MS,
  • Vijaytha Muralidharan, MD,
  • Doris Wong, BS,
  • Rory Sayres, PhD,
  • Michelle Phung, MS,
  • Nicolas Betancourt, MD,
  • Bradley Fong, BS,
  • Rachna Sahasrabudhe, BA,
  • Khoban Nasim, BS,
  • Alec Eschholz, BA,
  • Yossi Matias, PhD,
  • Greg S. Corrado, PhD,
  • Katherine Chou, MS,
  • Dale R. Webster, PhD,
  • Peggy Bui, MD, MBA,
  • Yuan Liu, PhD,
  • Yun Liu, PhD,
  • Justin Ko, MD, MBA,
  • Steven Lin, MD

Journal volume & issue
Vol. 2, no. 1
pp. 107 – 118

Abstract

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Objective: To understand and highlight the differences in clinical, demographic, and image quality characteristics between patient-taken (PAT) and clinic-taken (CLIN) photographs of skin conditions. Patients and Methods: This retrospective study applied logistic regression to data from 2500 deidentified cases in Stanford Health Care’s eConsult system, from November 2015 to January 2021. Cases with undiagnosable or multiple conditions or cases with both patient and clinician image sources were excluded, leaving 628 PAT cases and 1719 CLIN cases. Demographic characteristic factors, such as age and sex were self-reported, whereas anatomic location, estimated skin type, clinical signs and symptoms, condition duration, and condition frequency were summarized from patient health records. Image quality variables such as blur, lighting issues and whether the image contained skin, hair, or nails were estimated through a deep learning model. Results: Factors that were positively associated with CLIN photographs, post-2020 were as follows: age 60 years or older, darker skin types (eFST V/VI), and presence of skin growths. By contrast, factors that were positively associated with PAT photographs include conditions appearing intermittently, cases with blurry photographs, photographs with substantial nonskin (or nail/hair) regions and cases with more than 3 photographs. Within the PAT cohort, older age was associated with blurry photographs. Conclusion: There are various demographic, clinical, and image quality characteristic differences between PAT and CLIN photographs of skin concerns. The demographic characteristic differences present important considerations for improving digital literacy or access, whereas the image quality differences point to the need for improved patient education and better image capture workflows, particularly among elderly patients.