Design requirements for a teledermatology scale-up framework

Abstract

The value proposition of full-scale teledermatology is evidenced in the literature. The public health sector of South Africa's KwaZulu-Natal province began synchronous teledermatology in 2003, followed by spontaneous asynchronous (mobile) teledermatology in 2013. No scale-up has been formally planned. This paper establishes design requirements that will inform the identification or de novo development of a teledermatology scale-up framework. Methods: A requirements definition process with inductive reasoning approaches was applied. Analysis of semistructured interviews (19) with key teledermatology stakeholders (17) and observations from two teledermatology programmes, informed by lessons learned from prior teledermatology implementation attempts, eHealth scale-up literature and authors' expert opinion, led to identification of themes, and iterative reflection gave rise to categories and requirements. Results: Teledermatology scale-up framework design requirements emerged comprised of themes (4), categories (12), and specific design requirements (30). Discussion: This paper describes a process and resulting evidence-based (stakeholder interviews; programme observations; literature) and experience-based (expert opinion) design requirements to inform the identification and adoption / adaptation or de novo development of a Teledermatology Scale-up Framework (TDSF) for KwaZulu- Natal's public health sector. The proposed approach is recommended as a pre-requisite for scaling, including in other settings and for other telehealth applications.