New technology and working methods to improve healthcare for suspected malignant skin lesions: Implementation of teledermatoscopy in comprehensive healthcare

Abstract

Abstract Background Suspected malignant skin lesions are common and challenging in terms of diagnostic accuracy and lead time. Efficient use of teledermatoscopy has the potential to improve these factors. Objectives This report aims to explore the implementation of teledermatoscopy for quality improvement in a comprehensive healthcare system. Methods A stepwise implementation started in 2012 in the Stockholm Region, Sweden, serving 2.4 million inhabitants across approximately 240 primary healthcare centres. The full‐scale implementation occurred from May 2021 to February 2023, utilising a double‐reading teledermatoscopy system. The RE‐AIM framework (reach, effectiveness, adoption, implementation, maintenance) guided the evaluation, including measures such as participant engagement, referrals, diagnoses, staff participation, and centres going on post‐implementation. Descriptive statistics were used. Results In the full‐scale implementation period, 10,862 referrals were transmitted, with 17% recommended for biopsy or excision. Among these, 282 (15%) were confirmed melanomas and 516 (28%) non‐melanoma skin cancers. Challenges were observed during the stepwise phase, particularly in engaging primary healthcare and establishing dermatologic consultation capacity. However, all centres and 1263 primary care physicians participated in the fully scaled implementation. Challenges included contractual compliance, adopting a collective system perspective, effective management transition of referrals, cost allocation, and communication improvements. Six months post‐study, most centres used the system, with around 1500 monthly referrals. Conclusions The evaluation revealed the overall satisfactory performance of the teledermatoscopy system in terms of reach, effectiveness, adoption, implementation, and maintenance during the fully scaled phase. Results underscore the effectiveness of a stepwise implementation to successfully address contextual challenges. The findings emphasise the system's potential for a broader patient outreach. In conclusion, implementation of teledermatoscopy for quality improvement in a comprehensive healthcare system is an organisational challenge but has the potential to improve healthcare quality for suspected malignant skin lesions.

Keywords

• melanoma
• primary care
• skin cancer
• teledermatoscopy