Teledermatology Mobile Apps

Access to healthcare is currently a key priority for the Department of Veterans Affairs (VA).
The current practice of teledermatology in VA is effective but has not been uniformly
implemented, and inefficiencies in the current workstation-based process may discourage
teledermatology adoption by primary care clinics. VA Office of Connected Care developed a
mobile app, VA Telederm, as a more facile and efficient option that may enhance
teledermatology adoption among providers. Once patients establish care in a dermatology
clinic, they often need follow-up visits to evaluate responses to treatment and to adjust
management, neither of which necessarily requires a face-to-face visit. To address these
issues, OCC has additionally developed the My Telederm app to allow established dermatology
clinic patients to follow-up in person, the app may improve clinic access to in-person
dermatology clinics. The mobile apps are thus new programs that are planned for wide-spread
implementation in the VA. The investigators will conduct TWO SEPARATE TRIALS of database
reviews to understand how these two apps affect features of dermatology care, specifically
related to access to care.

Both apps will be made available over a 2 year period in a randomized, stepped-wedge design
to Veterans Health Administration (VHA) facilities. The VA Telederm app will be distributed
to 36 eligible VHA facilities that currently have low teledermatology activity and thus have
had relatively poor adoption of basic consultative teledermatology. The My Telederm app will
be distributed to 24 facilities with dermatology clinics that currently have relatively high
teledermatology activity and thus already have relatively mature teledermatology programs
ready for advanced operations.

By using health factors and stop codes unique to each app, the investigators will use the VA
Corporate Data Warehouse (CDW) to measure the impact of both apps in two separate trials on
outcomes reflecting dermatology access. At the end of the study period, the proposed research
will result in a novel documentation of mobile teledermatology's effectiveness in enhancing
Veteran's access to dermatology service. 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.

Inclusion Criteria:

- For the VA telederm trial, teledermatology at a site constituted a minimum of 0.1% and
less than 8.8% of all FY2016 dermatology encounters under secondary stop codes 695/696
(teledermatology readings).

- In total the investigators identified 36 sites eligible for VA Telederm.

- Conversely, the inclusion criterion for the second trial with My Telederm was that a
site had greater than or equal to 8.8% of all FY2016 dermatology encounters under
secondary stop codes 695/696.

- This indicated considerable pre-existing experience with consultative teledermatology
and the likely presence of dermatology reader and support personnel needed to
implement My Telederm.

- The investigators identified 24 sites eligible for My Telederm.

Exclusion Criteria:

- VA medical centers with no 695/696 stop code activity in FY2016 or with zero full-time
equivalent dermatologists were excluded since these sites likely lack the expertise,
support, and infrastructure to feasibly adopt teledermatology during the study period.

- The investigators also excluded sites outside the continental U.S., sites without a
dermatology clinic, and the 3 sites where the formative evaluation of this study will
be performed (i.e., Providence, RI; San Francisco, CA; and Denver, CO).