Comparing the top 5 previously used with current-primary platforms, EAs' RBO is materially smaller than CAs' and suggests that CAs experimented with significantly fewer platforms than EAs (mean plus/minus SD 2.3±1.4 vs 1.9 plus/minus 1.1, P=0.02). The RBO comparing the top 5 current primary platforms between EAs and CAs is 0.33, suggesting a material difference in practice-integrated platforms (Table 1). Compared with CAs, proportionally more EAs reported using platforms that required a mobile application [62.0% v 45.3%; chi-squared (2, n=322)=10.10, P=.006], were capable of uploading images [63.3% v. 42.0%; chi-squared (2, n=322)=12.00, P=.002], and allowed staff to join ongoing patient encounters [57.0% vs 32.5%; chi-squared (2, n=322)=15.65, P<.001; Table 2]. There was no statistical difference based on platform compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations [chi-squared (2, n=322)=3.56, P=.17].
There was a significant relationship between TAT and the self-reported largest barrier to implementing teledermatology [chi-squared (12, n=338)=26.35, P=.01; Table 3]. While concerns regarding image quality were most cited across groups, compared with EAs non-adapters (NAs) were 7x (OR 7.77, 95% CI 2.26-26.7) and CAs were 1.58x (OR 1.58, 95% CI 0.91-2.76) more likely to cite poor image quality as their largest barrier to implementation.
DISCUSSION
We have previously demonstrated a significant increase in synchronous/LI teledermatology, especially among CAs12,13; reflected here by the self-reported popularity of video-based platforms. The RBO analysis demonstrates material heterogeneity between EAs and CAs post-COVID platform usage, suggesting that CAs (largely private dermatologists) are using teledermatology differently than their EA (largely Academic/Government-based) peers.13 This is supported by
