JMIR Publications

ABSTRACT

Background:

Teledermatology can increase patient access, however its optimal implementation remains unknown.

Objective:

To describe and evaluate the implementation of a pilot virtual clinic teledermatology service at Duke University.

Methods:

Leaders within Duke Dermatology and Primary Care identified a teledermatology virtual clinic to meet patient access needs. Implementation was planned over the Exploration, Preparation, Implementation, and Sustainment phases. We evaluated the implementation success of teledermatology using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and prioritized outcome collection through a stakeholder survey. We used the electronic health record and patient surveys to capture implementation outcomes.

Results:

Our process consisted of primary care providers (PCPs) sending clinical and dermatoscopic images of patient lesions or rashes via e-communication to a teledermatology virtual clinic, with a subsequent virtual clinic scheduling of a video visit with the virtual clinic providers (resident or advanced practice provider, supervised by Dermatology attending) within 2-5 days. The teledermatology team reviews the patient image on the day of the video visit, gives their diagnosis and management plan with either no follow-up, teledermatology nurse follow-up, or in-person follow-up. Implementation at 4 pilot clinics, involving 19 referring PCPs and 5 attending dermatologists, began on 9/10/2021. As of 10/31/2021, 68 e-communications were placed (50 lesions and 18 rashes) and 64 virtual clinic video visits were completed. There were three patient refusals and one conversion to a phone visit. Participating primary care clinics differed in the number of patients referred with completed visits (range 2-32) and the percent of providers utilizing e-communications (range 13-53%). Patients were seen soon after the e-communication placement - compared to in-person wait times of >3 months, the teledermatology virtual clinic occurred on average 2.75 days after e-communication. Twenty percent of virtual clinic video visits were seen as in-person visit follow-up, suggesting that the majority of patients were deemed treatable in the virtual clinic. All patients returning the patient survey (n=10/10) agreed that their clinical goals were met during the virtual clinic.

Conclusions:

Our virtual clinic model for teledermatology implementation resulted in timely access for patients, while minimizing loss-to-follow up, and has promising patient satisfaction results. However, participating primary care clinics differ in their volume of referrals to the virtual clinic. As the teledermatology virtual clinics scales to other clinic sites, a systematic assessment of barriers and facilitators to its implementation may explain these inter-clinic differences.