Implementation of Mobile Teledermatology: Challenges and Opportunities.

Journal Article (Journal Article)

Background: While teledermatology is well-established in the Department of Veterans Affairs (VA), its implementation is far from complete. To facilitate consultative teledermatology and extend its reach, VA introduced a mobile teledermatology application (app) at three VA sites. Methods: We evaluated the initial implementation process using a mixed-methods, multiple case study approach to assess organizational readiness for change (ORC), which included examining facilitators, barriers, and contextual factors that affected implementation. We conducted: (1) group interviews and bimonthly reports to understand site processes; (2) semistructured interviews and surveys of individual participants representing a range of implementation roles; and (3) a review of internal organizational documents. We identified themes from interviews using an iterative process, and computed an ORC score based on surveys. Results: Forty-three individuals participated in the study. Qualitative data from all sites, corroborated by survey data available from one site, revealed a high readiness for change with an ORC score of 4.2, where 5 = maximal readiness for change. Facilitators included support from leadership and clinical champions, active telehealth programs, and an understanding and appreciation of the program and the resources needed. At all sites, however, technical issues negatively affected adoption; these included a suboptimal information technology infrastructure, which led to the inoperability of the app at two sites, and technical inefficiencies related to users' unfamiliarity with new devices and inconsistent internet access. Conclusions: Although a strong commitment to change and a confidence to effect change existed, these alone were insufficient to surmount barriers to implementation effectiveness. Clinical Trials Registration: NCT03241589.

Full Text

Duke Authors

Cited Authors

  • Peracca, SB; Fonseca, A; Hines, A; King, HA; Grenga, AM; Jackson, GL; Whited, JD; Chapman, JG; Lamkin, R; Mohr, DC; Gifford, A; Weinstock, MA; Oh, DH

Published Date

  • March 1, 2021

Published In

PubMed ID

  • 33691074

Electronic International Standard Serial Number (EISSN)

  • 1556-3669

Digital Object Identifier (DOI)

  • 10.1089/tmj.2020.0500

Language

  • eng

Conference Location

  • United States