TY  - JOUR
AU  - Walters, Laticha Elizabeth Marolana
AU  - Scott, Richard Ernest
AU  - Mars, Maurice
PY  - 2018
DA  - 2018/06/20
TI  - A Teledermatology Scale-Up Framework and Roadmap for Sustainable Scaling: Evidence-Based Development
JO  - J Med Internet Res
SP  - e224
VL  - 20
IS  - 6
KW  - teledermatology
KW  - scale-up
KW  - Teledermatology Scale-up Framework
KW  - TDSF
KW  - Teledermatology Scale-up Framework Implementation Roadmap
KW  - TDSF-IR
KW  - design science research
KW  - KwaZulu-Natal
KW  - South Africa
AB  - Background: The objectives of South Africa’s electronic health (eHealth) strategy recognize the value proposition that telemedicine practices hold for rural and urban referrals, but a lack of accepted and formalized scale-up has impeded realization of benefits. While both synchronous and asynchronous teledermatology exist, these remain localized and not scaled-up. Skin pathology is often the first sign of an HIV/AIDS infection, which remains a major cause of morbidity and mortality in South Africa. It is essential to replace the current inefficient dermatology referral process with a swift, organized, and efficacious one. Objective: The objective of this study is to present an evidenced-based teledermatology scale-up framework (TDSF) and implementation roadmap (TDSF-IR). Methods: A qualitative method with a design science research process model was used which consisted of 5 phases: (1) Awareness, which confirmed the need for an evidence-based TDSF and supporting TDSF-IR; (2) Suggestion, where a proposal was delivered on how to develop a TDSF and TDSF-IR; (3) Development, where we identified recommended design requirements and used these to identify and critique existing teledermatology or related scale-up frameworks; (4) Evaluation and validation, where we assessed outputs of the development phase against the design requirements and validated by confirming the veracity of the TDSF and TDSF-IR (validation involved 4 key senior teledermatology stakeholders using a questionnaire with a 5-point Likert scale); and (5) Conclusion, where validation results were used to finalize and communicate the TDSF and TDSF-IR to users. Results: The study identified 5 TDSF components: eHealth building blocks, eHealth strategic objectives and budget, scale-up continuum periods, scale-up drivers, and scale-up phases. In addition, 36 subcomponents were identified. Each was further characterized and described to enable design of the final evidence-based TDSF. An implementation roadmap (TDSF-IR) was also prepared as a guide for an implementer with step-by-step instructions for application of the TDSF. For the validation study of the TDSF and supporting TDSF-IR, 4 purposively selected key senior teledermatology management stakeholders were asked if they found it useful as a guide to assist the South African public health system with teledermatology scale-up. The mean (SD) of Likert-scale rating was 4.0 (0.53) where 4=Agree and 33 of 36 responses were either agree or strongly agree. Conclusions: This study developed a TDSF and supporting roadmap (TDSF-IR) that are evidence-based. The proposed approach and described tools could be adapted to assist with ensuring scale-up and sustainability for other eHealth practices in other locations. 
SN  - 1438-8871
UR  - http://www.jmir.org/2018/6/e224/
UR  - https://doi.org/10.2196/jmir.9940
UR  - http://www.ncbi.nlm.nih.gov/pubmed/29925492
DO  - 10.2196/jmir.9940
ID  - info:doi/10.2196/jmir.9940
ER  -