457 Teledermatology service quality improvement at the Southeast Veterans’ Integrated Service Network

Abstract

The Southeast Veterans’ Integrated Service Network (VISN7) has a robust teledermatology program providing services to community outpatient centers in Georgia, South Carolina and Alabama. Despite rapid growth of teledermatology across the Veterans Health Administration, there has not been standardization in teledermatology practices. To provide optimal, standardized consult readings among dermatologists at the VISN7, we examined adherence to 5 mutually agreed upon best practices. Quarterly from July 2018-August 2019, each physician was assigned a month to randomly review teledermatology consult cases and to evaluate if they adhered to the best practices. Evaluators commented on at least 3 of the 5 practices for each physician, marking “yes” or “no” for adherence. Overall, adherence to best practices was high among 7 dermatologists with an average adherence of 92.0% (Q1), 88.8% (Q2), and 93.0% (Q3). Between the first and last evaluation, 2 physicians improved adherence, 2 worsened adherence and 3 were consistently 100% adherent to all practices. Average adherence to each individual practice throughout the year was as follows: 1) Attendings should sign notes within 10 business days (100%); 2) Patients with cysts and keloids should be referred to general dermatology clinic initially (91%); 3) Primary care provider biopsy clinics should be utilized when available (80%); 4) The teledermatology nurse should be instructed to call patients prescribed oral corticosteroids and/or mid-to-high potency topical corticosteroids for follow-up, and to call patients prescribed topical fluorouracil or retinoids for education (91%); 5) Patients with cosmetic diagnoses should be aware of the VA non-cosmetic policy (64%). This study was limited to a 13-month review at a single facility and only examined 5 specific practices. We found high level of adherence to pre-specified practices and identified areas of improvement for dermatologists at the VISN7. Further studies are needed to examine whether adherence to these 5 practices improve patient outcomes.