title: Treatment of Infantile Hemangioma in Regional Hospitals With eHealth Support: Evaluation of Feasibility and Acceptance by Parents and Doctors.
abstract: BACKGROUND
  Since beta blockers became the preferred treatment for infantile hemangiomas (IH), the number of patients eligible for treatment is increasing. Currently treatment of IH with beta blockers is mainly reserved for expert centers, where wait times are lengthening. This demonstrated the need for development of a more efficient and accessible way of providing care for children needing treatment for IH. An eHealth intervention, Hemangioma Treatment Plan (HTP), was developed to treat IH in regional hospitals with online support from an academic doctor.
  
  
  OBJECTIVE
  Our goal was to evaluate the feasibility of the eHealth intervention by determining its use, acceptance, and usability. By evaluating the feasibility, usage can be predicted and points for improvement can be defined, thereby facilitating implementation of the intervention.
  
  
  METHODS
  Parents of children with an IH, presenting between October 2012 and November 2013 at the tertiary expert Center for Congenital Vascular Anomalies Utrecht, requiring treatment with a beta blocker, were asked to participate in the digital HTP. Both parents and regional doctors were sent a study questionnaire. Acceptance and usability of the HTP were evaluated by using the modified Technology Acceptance Model.
  
  
  RESULTS
  A total of 31 parents and 22 regional doctors participated in the eHealth intervention and received the questionnaire, and 25 parents and 15 doctors responded (response rates respectively 81% and 68%). A majority of the parents (96%, 24/25) and the regional doctors (87%, 13/15) considered the eHealth intervention useful in the care for IH. Most parents (76%, 19/25) and over half of the regional doctors (53%, 8/15) found the HTP easy to use. Technical problems using the HTP were reported by 28% (7/25) of the parents and 73% (11/15) of the doctors. The majority of parents (92%, 23/25) felt positive about usage of the HTP during treatment of their child. All regional doctors (100%, 15/15) felt positive about transition of treatment from the tertiary expert center to them, and 93% (14/15) felt positive about using the HTP.
  
  
  CONCLUSIONS
  Our eHealth intervention shows good feasibility, especially among parents. Improvement with respect to technical problems, training of regional doctors, and achieving organizational support might be needed for successful implementation in the future.
authors.affiliation: Wilhelmina Children's Hospital, University Medical Center Utrecht, Department of Pediatric Dermatology and Allergology, Utrecht, Netherlands.
authors.forename: Marlies
authors.identifier: http://orcid.org/0000-0001-9004-5111
authors.initials: M
authors.lastname: de Graaf
authors.forename: Joan Ee
authors.identifier: http://orcid.org/0000-0002-3231-4720
authors.initials: JE
authors.lastname: Totté
authors.forename: Harmieke
authors.identifier: http://orcid.org/0000-0003-3300-2101
authors.initials: H
authors.lastname: van Os-Medendorp
authors.forename: Wilco
authors.identifier: http://orcid.org/0000-0002-3215-3971
authors.initials: W
authors.lastname: van Renselaar
authors.forename: Corstiaan C
authors.identifier: http://orcid.org/0000-0003-3587-7489
authors.initials: CC
authors.lastname: Breugem
authors.forename: Suzanne Gma
authors.identifier: http://orcid.org/0000-0003-1018-4475
authors.initials: SG
authors.lastname: Pasmans
keywords: Internet; acceptance, usability; child; e-consulation, tertiary teledermatology; eHealth; infantile hemangioma; personal health record