Important IT Issues Impede Implementation of VA Mobile Teledermatology Application
To improve access to teledermatology for Veterans, VA created the web-based VA Telederm application (app), which interfaces with the EHR (electronic health record). The app streamlines the teledermatology process by automatically transferring the patient’s history from the primary care provider and, when used with a mobile device, enables the imager to capture skin images directly to the EHR, without retaining any images on the mobile device, thereby improving security and efficiency. This study evaluated the initial implementation process for the VA Telederm app – and assessed organizational readiness for change (ORC). Specifically, investigators examined facilitators, barriers, and contextual factors that affected implementation by conducting: 1) group interviews and bimonthly reports to understand site processes; 2) semi-structured interviews and surveys of individual participants representing a range of implementation roles; and 3) a review of internal organizational documents. VA Telederm was implemented at three VA facilities with mature consultative teledermatology programs. Overall, there were 43 stakeholder participants, including physicians, nurses, telehealth technicians, informatics support staff, administrators, and IT professionals.
- At all sites, technical issues including sub-optimal information technology infrastructure negatively affected adoption, leading to the inoperability of the app at two sites. There also were technical inefficiencies related to users’ unfamiliarity with new devices and inconsistent Internet access.
- Each site had a high level of organizational commitment for change, including support from leadership and clinical champions, but this was insufficient to surmount the technological barriers.
- Communication and early-user involvement encouraged individual and system-wide adoption. Thus, information obtained from users at an early stage of implementation provided an understanding of needed communication strategies.
- Leadership support, commitment to change, staff perceptions about the value of a change and their ability to implement it, and a clinical champion were important for implementation effectiveness, but were not enough to overcome technological barriers. Policies and practices relating to IT infrastructure and various technological difficulties with equipment, security applications, and Wi-Fi were also critically important. These barriers required additional time from users rather than freeing up time as the app intended.
- These qualitative data do not necessarily represent experiences and perceptions of staff throughout the entire VA healthcare system, but they do provide insight into some barriers and facilitators.
This study was partly funded by HSR&D (SDR 16-192). Drs. King, Jackson, Whited, and Chapman are with HSR&D’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT); Drs. Mohr and Gifford and Ms. Lamkin are with HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR); and Dr. Oh is part of the San Francisco VA Health Care System.
Peracca S, Fonseca A, Hines A, King H, Grenga A, Jackson G, Whited J, Chapman J, Lamkin R, Mohr D, Gifford A, Weinstock M, and Oh D. Implementation of Mobile Teledermatology: Challenges and Opportunities. Telemedicine and eHealth. March 1, 2021; online ahead of print.