# Benefits and Limitations of Teledermatology in German Correctional Facilities: Cross-Sectional Analysis

## TL;DR

This study examines how teledermatology helps provide skin care in German prisons, avoiding patient transport and highlighting challenges like image quality.

## Contribution

The paper presents a cross-sectional analysis of teledermatology in correctional facilities, emphasizing its practical benefits and technical limitations.

## Key findings

- 93.4% of teleconsultations were resolved using teledermatology without needing in-person follow-ups.
- Digital imaging quality was a persistent challenge, affecting diagnosis accuracy.
- Hybrid consultations improved knowledge exchange and training for in-house medical staff.

## Abstract

Teledermatology consultations offer the advantage of rapid diagnosis and care. Since 2019, our institute at the University Medical Center Hamburg-Eppendorf has been part of an interdisciplinary team for teledermatology support in German prisons as an alternative to extramural transports of patients.

This study aims to analyze the benefits and limitations of teledermatology for patients with limited access to medical specialties.

We conducted a descriptive cross-sectional analysis of 651 teleconsultations from prisons from February 2020 to April 2023. All cases were performed in a store-and-forward (asynchronous mode) and optional hybrid live (synchronous) consultation for the patient or in-house staff.

The main advantage of this case processing was the avoidance of external transport. Of the 651 teleconsultations, 608 (93.4%) could be finalized with telemedical support and 43 (6.6%) required additional workup, including verifications of the type of tumors (n=22, 51%), which needed biopsies, and open cases that were inflammatory (n=11, 26%) or involved infectious skin conditions (n=5, 12%). Digital imaging of the skin lesions improved with the experience of the personnel but remained a challenge, with the photo quality depending on the technical devices or available broadband supply.

Hybrid teledermatology consultation represents an effective and resource-saving method of providing specialized care to patients in situations with limited access to medical specialties. The video consultations with experts and exchange of knowledge about the cases presented opened the opportunity to support and train intramural colleagues. One of the main challenges remains the quality of digital imaging and transmission.