Background

TeleDermatology is a way for primary care providers to work with dermatologists at a distance. Veterans’ skin concerns are shared using clinical information and digital photos so dermatologists can give expert advice.

• TeleDermatology helps Veterans, especially in rural areas, get high-quality skin care when a dermatologist is not nearby.
• The program supports Veterans with many skin conditions, including psoriasis and skin cancers.
• To work well, TeleDermatology needs trained clinicians, support staff, and the right equipment.

The TeleDermatology Hub and Spoke Network Enterprise-Wide Initiative (EWI) is funded by the VA Office of Rural Health and managed by the Office of Connected Care and the Specialty Care Service Program Office. It provides resources to expand and strengthen TeleDermatology services for underserved rural Veterans.

• Since 2017, the TeleDermatology EWI has funded multiple VA facilities to grow TeleDermatology services.
• Across 26 projects, 23 hub sites with dermatologists support 243 rural spoke sites that refer Veterans for TeleDermatology consults.
• During the funding periods, more than 74,000 consults for rural Veterans have been completed, and from 2017–2024, the program has served over 360,000 Veterans overall.

Goals and Objectives

The TeleDermatology EWI aims to expand and maintain access to dermatology care for rural Veterans by giving facilities time and support to start and grow TeleDermatology services with rural clinics.

The program provides a three-year funding period to help new sites begin TeleDermatology, build strong processes, and plan for long-term sustainability.

Initial support includes funding for:

• Dermatology reader time at hub sites so dermatologists can remotely review skin images and clinical information from Veterans at rural spoke sites.
• Primary care provider time and support from nurses and telehealth technicians at rural spoke sites to refer Veterans to TeleDermatology, take high-quality photos of skin, and carry out dermatologist recommendations, including minor dermatologic procedures.
• Travel for dermatologists or rural primary care providers so they can provide or receive training to perform dermatologic procedures at rural locations.
• Equipment for TeleDermatology, such as cameras and related tools needed to capture and send clear skin images.

Methodology

TeleDermatology uses VA’s Electronic Health Record and, in some cases, telecommunications technology to let dermatologists evaluate a Veteran’s skin from a distance.

With this approach, a dermatologist helps primary care providers assess and manage skin conditions and, in some situations, may be directly involved in the Veteran’s care.

Rather than waiting for and traveling to a distant in-person dermatology appointment, Veterans can receive expert skin care closer to home and more quickly, often within about seven days.

Staff at local clinics capture images of the Veteran’s skin and enter clinical information into the electronic health record. These are then sent securely to TeleDermatology dermatologists, who review the consult and provide recommendations for diagnosis, treatment, and follow-up.

Impact on Rural Veteran Health

TeleDermatology has increased access to dermatology care for Veterans nationwide, especially those living in rural areas.

• In fiscal year 2024, TeleDermatology with in-clinic skin photography was used 199,792 times to support care for 189,613 Veterans.
• EWI-funded hubs provided over 76,000 of these encounters, with more than 20,000 for rural Veterans.
• Nearly 16% of all VA dermatology encounters in 2024 were completed using TeleDermatology.

The program also helps reduce travel and wait times for rural Veterans and supports more timely diagnosis and treatment of skin disease, including skin cancer.

• Before TeleDermatology, rural Veterans often traveled 37–42 miles farther than urban patients for in-person dermatology care.
• With TeleDermatology, rural Veterans can have photos taken at local primary care clinics, and dermatologists respond to consults within seven days in more than 96% of cases.
• In recent funding periods, two EWI sites increased the number of rural Veterans served by 84% and 95%, surpassing national growth rates of 62% and 57%.
• TeleDermatology training has helped primary care providers perform skin biopsies locally, reducing delays and extra travel for Veterans.
• In fiscal year 2024, EWI-funded sites more than doubled the number of lesions coded as “Neoplasms of Uncertain Behavior,” reflecting more timely workup of suspicious skin tumors.

TeleDermatology also supports long-term sustainability and potential cost savings for VA.

• From fiscal year 2017 through 2024, EWI-funded hubs completed more than 360,000 TeleDermatology consults.
• Facilities report ongoing training needs; in fiscal year 2024, four funded facilities trained 14 additional clinical and non-clinical staff for TeleDermatology work.
• At 30 VA facilities linked to 59 rural clinics without local dermatology, community care dermatology costs reached nearly $52 million in fiscal year 2023, highlighting the potential value of expanding TeleDermatology to provide more services within VA.

Key Takeaways

• Enhanced access for rural Veterans with skin disease: TeleDermatology expansion has given Veterans at rural sites better access to dermatologists. Rural sites funded by the TeleDermatology EWI often have better dermatology access than unfunded or even urban sites.
• Training clinicians in dermatology: Since 2017, TeleDermatology EWI funding has helped train more than 500 clinicians and support staff, which strengthens the program and helps maintain its benefits over time.
• Potential cost reductions: As community care remains a major expense for VA, TeleDermatology may help lower costs by providing dermatology services within VA and reducing the need for outside referrals.
• Sustainability and growth: Nearly all EWI-funded sites remain active and continue to grow by adding new rural sites, increasing the share of dermatology care delivered through TeleDermatology, and training more staff. Over the past year, TeleDermatology services for rural Veterans have expanded by about 50%.

Download the Printable PDF for Healthcare Providers and Researchers.

References

• Darkins A. The growth of telehealth services in the Veterans Health Administration between 1994 and 2014: a study in the diffusion of innovation. Telemed J E Health. 2014;20(9):761-768.
• Landow S.M., Oh D.H., Weinstock M.A. TeleDermatology within the Veterans Health Administration, 2002-2014. Telemed J E Health. 2015;21(10):769-773.
• Peracca S.B., et al. Implementation of TeleDermatology: Theory and practice. Current Dermatology Reports. 2019;8:35-55.
• Peracca S.B., et al. Implementing TeleDermatology for Rural Veterans: An Evaluation Using the RE-AIM Framework. Telemed J E Health. 2021;27(2):218-226.
• Lamkin R., et al. RE-AIM Framework-Based Implementation Evaluation of TeleDermatology Programs to Serve Rural Veterans. Health Serv Res. 2020;55(S1):59-60.
• Lamkin R.P., et al. Using the RE-AIM framework to assess national TeleDermatology expansion. Front Health Serv. 2023;3:1217829.

Contact

• Dennis H. Oh, MD, PhD, TeleDermatology Co-Lead, Connected Care/Digital Health Office, San Francisco VA Medical Center, San Francisco, CA. Dennis.Oh@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD PRFY-00547.
• Suggested Citation: Oh, D. H., & Weinstock, M. A. (2025). TeleDermatology Hub and Spoke Network. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp