December 2018

In This Issue: Advances in Telehealth
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Teledermatology Mobile Apps Improve Veterans’ Access to Dermatology

Feature Article

Teledermatology has emerged as an effective option to enhance access to high-quality skin care in the VA healthcare system. VA's Office of Health Informatics has developed two innovative mobile apps for VA teledermatology:

• VA Telederm streamlines the current workstation-based consultative process between primary care providers, teledermatology imagers, and dermatologists, and is intended to lower the threshold for using teledermatology in VA primary care clinics.

• My VA Images allows established dermatology patients to follow-up with VA dermatologists remotely rather than using in-person, clinic-based appointments.  VA dermatologists will use the Patient Viewer 4.1 app that has been developed specifically to interact with My VA Images. Together, these apps are intended to reduce the distances that patients must travel to dermatology clinics and to improve the reliability of follow-up. They also are anticipated to free up appointment slots for new and established patients who must be seen in-person.

This ongoing (2016–2020) HSR&D study is testing the implementation of these apps and whether they will facilitate Veterans’ access to dermatologic care at the San Francisco, Denver, and Providence VA Medical Centers. Each mobile app and its associated technical and clinical support resources will be rolled out in a randomized trial involving VA sites most likely to benefit from their use. Study investigators will compare outcomes for sites that have received the app to those that have not, including the impact of apps on access to dermatology care, as well as the factors that affect personal and organizational adoption of mobile apps. Further, investigators will measure access to dermatology care by:

• Comparing intervention and control groups with respect to all dermatology consult and appointment completion times;
• Examining geographic access, such as travel distance and rurality; and
• Analyzing total access which is reflected in the total instances of care as indicated by the numbers of dermatology/teledermatology encounters.

In addition, outcome measures for the My VA Images/Patient Viewer will include the timeliness of follow-up with respect to the target date, the no-show rate, and the proportion of new patients in conventional dermatology clinics.

Findings: To be determined.

Impact:
Research findings will document mobile teledermatology's effectiveness in enhancing Veterans' access to dermatology services, as well as produce a comprehensive understanding of the factors leading to successful mobile telehealth implementation. The results will be of significance to VA as it develops and implements other mobile telehealth programs, and more generally to other healthcare organizations planning for large-scale telehealth interventions.

Principal Investigator: Dennis Oh, MD, PhD, is an HSR&D affiliate investigator and part of the San Francisco VA Health Care System.  Co-PI Martin Weinstock, MD, PhD, is an HSR&D affiliate investigator and part of the Providence VA Medical Center.

Publications: Done N, Oh D, Weinstock M, et al.  VA Telederm study:  Protocol for a stepped-wedge cluster randomised trial to compare access to care for a mobile app versus a workstation-based store-and-forward teledermatology process. BMJ Open 2018; 0:e022218.  doi:10.1136/bmjopen-2018-022218.

View project abstract.