Systematic human factors evaluation of a teledermatology system within the U.S. military

The benefits of telemedicine systems within the U.S. military have been widely recognized. However, a number of telemedicine systems have encountered resistance and have failed to be adopted and widely used. The purpose of the present project was to use a human factors analysis to characterize the facilitators and impediments to the use of a teledermatology system. More specifically, the goal was to investigate areas such as training, workload distribution, and communication between team members because these topics can be broadly classified as human factors issues. Across different sites, structured interviews were administered to three user groups within the system (i.e., consult managers, primary care managers who are comparable to civilian primary care physicians, and dermatologists). All three user groups reported that system support, speed, personal benefits, and increased education and experience were facilitators to system use; impediments were usability problems and insufficient training. However, each user group also identified unique facilitators and impediments. For example, users at the referring site (consult managers and primary care managers) focused on workload distribution among team members and the importance of onsite support as facilitators. In contrast, key facilitators for physicians (primary care and dermatologists) were effective communication, professional benefits, and increased quality of patient care. Human factors issues are critical for successful telemedicine systems and user issues may vary across user groups. The method reported herein provides guidance for development of new telemedicine systems and evaluation of existing telemedicine systems to increase adoption and usage.