Disparities in Initial Usage of Direct-to-Patient Teledermatology: A Retrospective Observational Study.

Peracca SB, Sturgeon DJ, Lamkin RP, Zepeda ED, Mohr DC, Lachica O, King HA, Jackson GL, Morris IJ, Gifford AL, Whited JD, Weinstock MA, Oh DH. Disparities in Initial Usage of Direct-to-Patient Teledermatology: A Retrospective Observational Study. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2026 Jun 15; 15305627261458160, DOI: 10.1177/15305627261458160.

Related HSR&D Project(s)

• SDR 16-192 – Teledermatology mobile apps: Implementation and impact on Veterans' access to dermatology

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Abstract:

BACKGROUND: While telehealth has potential to enhance patients' access to care, uneven implementation may limit its impact. My VA Images ( < i > MVAI < /i > ), a clinician-gated, patient-facing asynchronous teledermatology application developed by the Department of Veterans Affairs (VA) was piloted at three VA facilities, and then sequentially offered to groups of seven facilities every 3 months for 1 year. We characterized patients who were exposed to and used < i > MVAI < /i > and we identified associated characteristics. METHODS: We used VA's mobile health and administrative databases to examine < i > MVAI < /i > activity and dermatology patient demographics over a 17-month period during 2019 and 2020. RESULTS: At 11 VA facilities, 494 established dermatology patients were invited to a follow-up visit using < i > MVAI < /i > . Invitees were more likely than Non-Invitees to be White and urban, have shorter drive times to specialty care, and have more outpatient and dermatology visits before and after < i > MVAI < /i > use. Forty-eight percent of Invitees successfully used < i > MVAI < /i > and were most likely to do so in the 8-30 day interval. Successful Users were more likely than Unsuccessful Users to be younger and have a dermatology visit 1 year after < i > MVAI < /i > use. Patients requiring multiple attempts before successfully using < i > MVAI < /i > were older than initially Successful Users, though younger than Unsuccessful Users. CONCLUSIONS: Not all patients benefited equally during the initial rollout of < i > MVAI < /i > . Disparities in VA where other forms of patient-facing telehealth are already common illustrate challenges for health care organizations in equitably implementing direct-to-patient teledermatology. Specific groups may benefit from targeted outreach or support.