Case Study: Implementing Teledermatology in Urban Primary Care Clinics

Thesis Abstract

Teledermatology has emerged as a potential solution to address dermatology access gaps in urban primary care clinics, where primary care physicians often manage skin conditions with delayed specialist input, leading to diagnostic uncertainty and prolonged patient wait times. This study investigates the implementation of a teledermatology program across five urban primary care clinics in a metropolitan health system, focusing on adoption, clinical workflow integration, patient outcomes, and clinician satisfaction, to understand barriers and enablers within a real-world setting. The aim is to evaluate how teledermatology affects diagnostic accuracy, access to dermatology consultations, and care pathways, and to derive actionable recommendations for scalable integration in similar urban contexts. Specific objectives include (1) assessing changes in wait times for dermatology consultations and referral rates pre- and post-implementation, (2) evaluating diagnostic concordance between primary care physicians and dermatologists using store-and-forward imaging, (3) examining patient-reported outcomes such as satisfaction and perceived quality of care, (4) identifying workflow adaptations required to integrate teledermatology into existing clinic processes, and (5) exploring perceived barriers and facilitators from clinicians’ and patients’ perspectives through thematic analysis. The methodological approach adopts a mixed-methods sequential explanatory design. The quantitative strand pursues a quasi-experimental controlled before-and-after comparison, enrolling 1,200 patient encounters across the five clinics over 12 months prior to and after program rollout. Data collection utilizes electronic health records for service utilization metrics, standardized dermatology diagnostic codes, and wait-time measurements, complemented by patient satisfaction surveys administered at follow-up. Diagnostic concordance will be quantified using Cohen’s kappa and percent agreement between primary care assessments and teledermatology-referred dermatology diagnoses. The qualitative strand employs semi-structured interviews with 30 clinicians and 40 patients, analyzed through thematic analysis to extract themes regarding acceptability, perceived value, and implementation challenges. Validity and reliability are ensured via instrument pre-testing, triangulation of quantitative and qualitative data, and inter-coder reliability assessment for qualitative coding. Regression analyses will examine predictors of diagnostic concordance and wait-time reductions, while ANOVA will compare satisfaction scores across clinics and over time. A conceptual framework anchored in the Technology Acceptance Model (TAM) and the Diffusion of Innovations theory will guide interpretation of adoption patterns, with attention to perceived usefulness, ease of use, compatibility with clinical workflows, and social system factors within the urban primary care environment. Anticipated findings include meaningful reductions in wait times for dermatology input, improved diagnostic concordance relative to baseline, and higher patient satisfaction where teledermatology was fully embedded into workflow. It is expected that success correlates with robust clinician training, streamlined image capture protocols, prompt feedback cycles from dermatologists, and explicit governance for data privacy and medico-legal risk. The study contributes to knowledge by providing empirical, context-specific evidence on the scalability of teledermatology in dense urban primary care settings, detailing organizational and clinical determinants of successful implementation, and offering a validated measurement approach for impact assessment in similar health systems. The findings will inform policy and operational guidelines for surrogate dermatology access, including criteria for case triage, imaging standards, and integration with existing electronic medical records. The primary conclusion is that teledermatology can meaningfully enhance access and diagnostic quality in urban primary care when supported by structured workflows, continuous training, and active stakeholder engagement. Recommendations include developing standardized image Acquisition Protocols, establishing performance dashboards for wait times and concordance, creating dedicated teledermatology coordinators, and scaling the model with phased pilot-testing in additional clinics, while ensuring ongoing evaluation of equity outcomes across diverse patient populations.