Implementation of Direct-to-Patient Mobile Teledermatology in VA

Area of Science:

• Health Informatics
• Telemedicine
• Dermatology

Background:

• Innovative technology can improve healthcare access, but effective implementation is crucial.
• The Department of Veterans Affairs (VA) introduced My VA Images, a direct-to-patient mobile app for asynchronous teledermatology follow-up care.

Purpose of the Study:

• To evaluate the implementation of the My VA Images mobile application within the VA healthcare system.
• To assess the effectiveness of a direct-to-patient asynchronous teledermatology app.

Main Methods:

• A stepped-wedge cluster-randomized design was used across 28 VA facilities.
• Qualitative and quantitative data were collected, including encounter data, app usage, facility reports, clinician interviews, and communications.
• The Organizational Theory of Implementation Effectiveness guided the examination of implementation factors.

Main Results:

• Implementation policies included expanding home telehealth and marketing strategies.
• The COVID-19 pandemic significantly impacted implementation, affecting staffing, demands, and stakeholder attitudes.
• Implementation effectiveness was mixed; 19 of 31 facilities prepared to use the app, with 7 using it as intended. Physician extenders were more likely to use the app than attendings. Facilities implementing pre-pandemic showed better sustained use.

Conclusions:

• Mobile teledermatology implementation showed considerable heterogeneity within the VA.
• Targeting favorable facilities and user groups, and addressing barriers like EHR integration and staffing, can optimize telehealth impact.
• The COVID-19 pandemic emerged as a significant external barrier to implementation.