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Teledermatology Outcomes in the Providence Veterans Health Administration.

BACKGROUND
As technology evolves, so does the integration of technology into health care delivery. Telemedicine, the use of information technology to provide remote health care, aims to improve patient access to quality care across a wide range of barriers.


INTRODUCTION
Our objective was to determine whether teleconsultation leverages specialist expertise at one site within the United States' largest integrated health system. We evaluated the Providence Veterans Affairs Medical Center (PVAMC) teledermatology store-and-forward program.


MATERIALS AND METHODS
We evaluated 460 completed teleconsultations using retrospective chart review at the PVAMC in June-August 2016 for 12 postimaging outcomes, with no exclusion criteria. We determined outcomes using Computerized Patient Record System chart reviews.


RESULTS
Dermatologists completed 84-99% of all teleconsultations within 1 week after referral. Fifty one percent (51%) of patients required no dermatology clinic visit. Six percent (6%) of all teleconsultations were ultimately diagnosed with a biopsy-proven skin cancer. Sixty nine percent (69%) of referring providers prescribed recommended medications within 7 days.


DISCUSSION
We conclude that the PVAMC teledermatology program enables rapid access to dermatologic expertise while avoiding unnecessary clinic appointments.


CONCLUSION
By detecting both weak links, and steps in the chain of care that successful teledermatology requires, our findings can help teledermatology systems within and outside the Veterans Affairs maximize their effectiveness.