JMIR Publications

ABSTRACT

Background:

Despite the global upscale of teledermatology during the COVID-19 pandemic, persistent barriers, such as the quality of the anamnesis and photos, continue to hinder the effective use of teledermatology in practice. A better understanding of the dermatologists’ experiences and satisfaction with using the teledermatology system necessitates surveying. A holistic evaluation may provide valuable insight to understand how barriers interrelate which is deemed necessary for the innovation of teledermatology in practice.

Objective:

We aim to understand dermatologists’ experience and satisfaction with their training, support communication, interaction and usage of a teledermatology platform of a Dutch digital hospital during the COVID-19 pandemic.

Methods:

An online questionnaire was sent in December 2021 to Dutch dermatologists who 1) had an active teledermatology platform account, and 2) responded to a teledermatology consultation between 01-10-2019 and 30-09-2021. The questionnaire consisted of questions from the validated SAF-TSUQ questionnaire, and new questions regarding; demographics of teledermatologists, the use of teledermatology during the COVID-19 pandemic, the performance of teledermatology by general practitioners (GP), and the role of dermatologists in the teledermatology process. The open-ended questions were analysed by a grounded theory approach guided by a sociotechnical model and complemented by a complex adaptive system perspective. A panel discussion with three dermatologists was performed to provide additional insight into the responses to the questionnaire.

Results:

We obtained responses from 25 out of the 249 invited dermatologists (10%). Overall, dermatologists had a positive experience with teledermatology. Interestingly, the frequency of teledermatology use was unaffected by the COVID-19 pandemic. However, the insufficient quality and incompleteness of the clinical content (photos and anamneses information) of the teledermatology consultation were experienced as critical factors impacting the efficiency of the teledermatology workflow. Dermatologists expressed the need to improve these aspects to avoid a time-consuming process or the need to request physical referrals of patients. Questionnaire responses were confirmed and enriched during the panel discussion and potential solutions to enforce more complete anamnesis information (e.g. mandatory fields) were suggested.

Conclusions:

Dermatologists see teledermatology as a valuable tool to provide access to dermatology care. However, the quality and completeness of the provided photos and anamnesis information need to be improved to guarantee the effectiveness and efficiency of the complex teledermatology system. This could increase both the dermatologists’ satisfaction and the quality of teledermatology services. Implementing teledermatology requires management of trade-offs such as time investments (workload) of practitioners in taking images versus image quality. Teledermatology implementation should be assessed from a complexity perspective to under trade-offs as a means of preventing unintended consequences.