Handoff Delays in Teledermatology Lengthen Timeline of Care for Veterans With Melanoma

Store-and-forward teledermatology (SFT) involves sending clinical images and patient information to a dermatologist for evaluation and is widely used in US Department of Veterans Affairs (VA) Veterans Integrated Service Network 20. While SFT has increased access to dermatologic care, its impact on timely treatment is less well known. This study compares the timeline of care for melanoma treatment between SFT and face-to-face (FTF) dermatologic care and identifies potential areas for SFT improvement.

This study at the VA Puget Sound Health Care System included 107 patients in the FTF group and 87 patients in the SFT group. Electronic health record data were reviewed and key dates were extracted for patients in each group, including entry into episode of care (EEC), biopsy, and definitive excision. Median and mean intervals were compared between groups. To further analyze the groups, the FTF group was subdivided into where melanomas were entered into care, either at a dermatology clinic (FTF dermatology) or a primary care/nondermatology setting (FTF primary care).

The median intervals from EEC to definitive excision for patients in the FTF and SFT groups were 58 and 73 days (P = .004), respectively. The median intervals from EEC to definitive excision in the FTF dermatology and FTF primary care groups were 37 and 78 days, respectively. Handoffs in SFT accounted for 6 to 12 days of the total timeline of care.

The fastest timeline of care for primary cutaneous melanoma is obtained when FTF dermatology is the EEC. The SFT timeline is significantly longer than that of FTF. Facilitating handoffs in SFT presents an opportunity for process improvement. The SFT timeline could be improved if the EEC, imaging, and SFT consultation requests all occurred on the same day.