Biagio-de Jager, LeighSwanepoel, De WetAdeyemo, AdebolajoHall, James WilburVinck, Bart M.2013-02-202013-02-202013-04Swanepoel, DW, Adeyemo, A, Hall, JW & Vinck, B 2013, 'Asynchronous video-otoscopy with a telehealth facilitator', Telemedicine and e-Health, vol. 19, no. 4, pp. 1-7.1530-5627 (print)1556-3669 (online)10.1089/tmj.2012.0161http://hdl.handle.net/2263/21124OBJECTIVE: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. SUBJECTS AND METHODS: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. RESULTS: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from videootoscopic images acquired by the otolaryngologist and facilitator (j = 0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. CONCLUSIONS: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings.en© MARY ANN LIEBERT, INC.TelehealthTelemedicineMedical telematicsTelecommunication in medicineArticle