Implementation and Impact of a Dermoscopy-Enabled Dermatology eConsult Application in Primary Care

Primary care providers (PCPs) can help fill gaps in access to dermatology care using eConsults to collaborate asynchronously with dermatologists. Many dermatology eConsult programs face challenges with image acquisition, image quality, lack of dermoscopy and complicated, time-consuming workflows that limit primary care acceptance.

This quality improvement study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. We introduced a dermoscopy-enabled dermatology eConsult device and application (DermLoop) to PCPs at a statewide Federally Qualified Health Center (FQHC) and compared dermatology referrals during the 9-month periods pre-DermLoop versus post-DermLoop.

Sixty-nine PCPs at 16 practice sites submitted 560 DermLoop eConsults for 526 unique patients. After being trained to use DermLoop PCPs (n = 65) submitted a higher proportion of dermatology referral requests as eConsults rather than face-to-face visit (28.6% vs 17.3%, P < .001, r = 0.39). Most DermLoop eConsults (79.8%) allowed patients to avoid a face-to-face visit. DermLoop provided improved image quality and resulted in high PCP-user satisfaction.

Broad adoption of DermLoop eConsults helped provide effective dermatology care to Medicaid-insured and uninsured patients who may otherwise have been unable to obtain care.