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Implementation of teledermatology for Veterans in the United States
ABSTRACT
The United States' Department of Veterans Affairs (VA) has adopted teledermatology, predominantly asynchronous, as an important strategy for improving access to expert skin care for its 9 million enrolled Veteran patients. Despite the measurable success of its teledermatology program, one-fifth of all points of care have yet to implement teledermatology. The application of implementation science approaches offers the opportunity to systematically understand VA's teledermatology experience to yield insights and lessons for implementing teledermatology widely as well as locally. Implementation frameworks and theories will be discussed, including the use of Organizational Readiness for Change instrument as a prognosticator for implementation success, and the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to assess the longitudinal implementation of a teledermatology initiative for rural Veterans. Development and implementation of new technological innovations that introduce new and perturbed teledermatology workflows into mature teledermatology environments will also be analyzed, including behaviors during the COVID-19 pandemic.
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