The Utilization and Impact of Live Interactive and Store-and-Forward Teledermatology in a Veterans Affairs Medical Center During the COVID-19 Pandemic

Castillo, Francine T.; Peracca, Sara; Oh, Dennis H.; Twigg, Amanda

doi:10.1089/tmj.2021.0275

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…Ironically, while telehealth was a critical healthcare delivery strategy during the pandemic, which increased dermatologists’ interest in MVAI ’s potential value, numerous competing demands on staff by VA, including promotion of other telehealth pathways, also increased during the pandemic, leading to a fragmented or distracted implementation climate at some facilities. 22 , 41 Thus, we observed that facilities that had been exposed to MVAI before the pandemic had implementation climates that were better prepared for MVAI usage and more likely to achieve key milestones.…”

Section: Discussionmentioning

confidence: 85%

“…Home-based telehealth has had an increasing presence in VA and in healthcare generally. 22 – 27 Direct-to-patient asynchronous teledermatology has been studied in research settings with defined diseases and populations. 28 – 30 However, differences in how innovative interventions are implemented among different organizations may exist.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of Direct-to-Patient Mobile Teledermatology in VA

Peracca,

Lachica,

Lamkin

et al. 2024

J GEN INTERN MED

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Background Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. Objective We evaluated Department of Veterans Affairs’ (VA’s) implementation of My VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person. Design /Participants/Approach Following pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app’s implementation using qualitative and quantitative data consisting of encounter data from VA’s corporate data warehouse; app usage from VA’s Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff. Key Results Implementation policies and practices included VA’s vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process. Conclusions Considerable heterogeneity existed in implementing mobile teledermatology, despite VA’s common mission, integrated healthcare system, and stakeholders’ broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier. Clinical Trials Registration NCT03241589

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Implementation of Direct-to-Patient Mobile Teledermatology in VA

Peracca,

Lachica,

Lamkin

et al. 2024

J GEN INTERN MED

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“…To address the dermatological needs of patients over the last two years, teledermatology services have undergone a dramatic shift and upscale nationwide including at the SFVAHCS [24,25]. Our work, which provides suggestions for the limited use of teledermoscopy, could interest healthcare leaders and teledermatology providers looking to study ways to increase the efficiency of the growing systems where they practice [26].…”

Section: Discussionmentioning

confidence: 97%

Limited impact of teledermoscopy on referrals to face-to-face dermatology

Montejano¹,

Oh²,

Twigg³

2022

DOJ

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“…1 , 13 This often includes sharing of dermatologic photos shared with a consulting dermatologist. 1 While asynchronous evaluations were not included in the telehealth reimbursement expansion and did not experience a similar level of uptake as synchronous teledermatology, 79 the store-and-forward modality is important to discuss, as it was the most utilized form of teledermatology before the pandemic. 7 , 20 …”

Section: Asynchronous Store-and-forward Evaluationsmentioning

confidence: 99%