A process modelling approach to assess the impact of teledermatology deployment onto the skin tumor care pathway

Background: In dermatology, telehealth was raised as a potential answer to increase access and decrease delay for skin cancer management, especially in the elderly population. However, the influence of teledermatology in the care pathway of non-melanoma skin cancer (NMSC) has never been studied. Objectives: To evaluate teledermatology (TD) deployment implications in NMSC care pathways by comparing a conventional care pathway prior to TD integration to the pathway after TD implementation using a process modelling approach. Patients and Methods: Two retrospective studies were conducted in a department of dermatology with an ongoingTDprogram with geriatric institutions. One study (study 1) mapped NMSC care pathway prior to TD integrationfrom January to February 2013. Another determined NMSC care pathway (study) for patients managed afterTDdiagnosisfrom September2016 to October 2018, during thesame period patients managed by conventional care process were used as controls. Patients characteristics, type of tumors and processes were compared using time as a key performance indicator. Results: 89 NMSC patients were managed in the department (mean age= 76 yr old ± 13) during the study 1 period while from September 2016 till October 2018, 36 patients NMSC were managed after TD, mean age of 89 years old ± 6 and 681 patients were managed in a conventional process, mean age of 78 years old ±12. There was no significant difference in delays between: first in-person or TD consultation and biopsy, biopsy and multidisciplinary consultation, or biopsy and surgery. NMSCpatients consulting through TD had significantly longer delays between: first consultation and multidisciplinary consultation, multidisciplinary consultation and surgery, and first consultation and surgery (p=0.037, p=0.02, p