Implementation of Mobile Teledermatology: Challenges and Opportunities
Publication: Telemedicine and e-Health
Volume 27, Issue Number 12
Abstract
Background: While teledermatology is well-established in the Department of Veterans Affairs (VA), its implementation is far from complete. To facilitate consultative teledermatology and extend its reach, VA introduced a mobile teledermatology application (app) at three VA sites.
Methods: We evaluated the initial implementation process using a mixed-methods, multiple case study approach to assess organizational readiness for change (ORC), which included examining facilitators, barriers, and contextual factors that affected implementation. We conducted: (1) group interviews and bimonthly reports to understand site processes; (2) semistructured interviews and surveys of individual participants representing a range of implementation roles; and (3) a review of internal organizational documents. We identified themes from interviews using an iterative process, and computed an ORC score based on surveys.
Results: Forty-three individuals participated in the study. Qualitative data from all sites, corroborated by survey data available from one site, revealed a high readiness for change with an ORC score of 4.2, where 5 = maximal readiness for change. Facilitators included support from leadership and clinical champions, active telehealth programs, and an understanding and appreciation of the program and the resources needed. At all sites, however, technical issues negatively affected adoption; these included a suboptimal information technology infrastructure, which led to the inoperability of the app at two sites, and technical inefficiencies related to users' unfamiliarity with new devices and inconsistent internet access.
Conclusions: Although a strong commitment to change and a confidence to effect change existed, these alone were insufficient to surmount barriers to implementation effectiveness. Clinical Trials Registration: NCT03241589
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Information & Authors
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Published In
Telemedicine and e-Health
Volume 27 • Issue Number 12 • December 2021
Pages: 1416 - 1422
PubMed: 33691074
Copyright
Copyright 2021, Mary Ann Liebert, Inc., publishers.
History
Published online: 13 December 2021
Published in print: December 2021
Published ahead of print: 1 March 2021
Accepted: 4 January 2021
Revision received: 30 December 2020
Received: 10 November 2020
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Disclosure Statement
No competing financial interests exist.
Funding Information
Work was supported by VA Health Services Research and Development award HX-17-007 (Dennis H. Oh and Martin A. Weinstock), VA Office of Rural Health (Dennis H. Oh and Martin A. Weinstock), National Clinician Scholars Program at University of Michigan (Aliya Hines), the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT, CIN 13-410), and Center for Healthcare Organization and Implementation Research (CHOIR, CIN 13-403, Andrea M. Grenga). Views expressed in this article are those of the authors and do not represent the Department of Veterans Affairs or the U.S. government.
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