Digital dermatology in general practice:Past, present and future

General practitioners (GPs) serve as gatekeepers for patients seeking specialized dermatology care and play a crucial role in triaging patients with skin lesions. To support GPs in diagnosing these (suspicious) skin lesions in general practice, they can seek the advice of a teledermatologist through digital dermatology services. This thesis aimed to contribute to understand the value of store-and-forward digital dermatology consultation in Dutch general practice. Furthermore, this thesis aimed to provide insights into experienced facilitators and barriers in the uptake of these digital dermatology services by GPs since its introduction in primary care. First, we investigated the status of two decades of teledermatology worldwide by performing a literature review (Part I). Second, we researched the impact and added value of performing store-and-forward teledermoscopy for GPs in Dutch GP practice (Part II). Finally, we developed and validated a quality feedback tool (SAF-TSUQ) to determine GPs’ perspectives about store-and-forward telemedicine services. We applied and extended this SAF-TSUQ to reveal the factors that facilitate or impede the successful implementation and use of teledermatology, teledermoscopy and dermatology home consultation services in Dutch GP practice (Part III). The evidence from this thesis showed that teledermatology and teledermoscopy are of added value for GPs. These services save cost and time compared to traditional dermatology care and support GPs in their referral decisions for benign and malignant skin lesions. Barriers hinder the full potential of digital dermatology services and addressing these sociotechnical challenges is crucial for enhancing and expanding these services in future general practices

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

The value of teledermoscopy to the expertise of general practitioners diagnosing skin disorders based on ICD-10 coding

Early recognition of skin cancer is vital to enhance patient outcomes. Teledermoscopy (TDsc), a telemedicine service, supports general practitioners (GPs) in gaining fast access to dermatologists' feedback to detect skin cancer. This study aimed to assess if GPs gain expertise in diagnosing skin disorders after continued use of TDsc, based on diagnosis classification by the International Statistical Classification of Diseases and Related Health Problems (ICD-10). A retrospective study was conducted on TDsc consultations sent by GPs to teledermatologists in the Netherlands (July 2015 - June 2018). GP sensitivity and confirmed cases in diagnosing skin disorders slightly increased over time. However, the total positive predictive value showed a decrease. In three years, 43 melanomas were diagnosed by the TD for which the GP did not provide a (correct) pre-diagnose. Though GPs appear to improve their expertise in skin disorder detection after continued TDsc use, TDsc remains imperative to early melanoma detection

Practical issues arising from the use of telemedicine applications: An evaluation of equipment used for colour imaging in teledermatology, automated weight monitoring and patient-operated 12-lead ECG recording in arrhythmia.

Three telemedicine applications which depend on relatively simple telephone technology to transfer data in the care of patients managing chronic conditions at home are investigated in order to evaluate their application from the users’ perspectives. Part one provides an evaluation of four mobile cameraphones, of varying quality, such as those commonly used to photograph patients for remote diagnosis. The cameraphones are compared with a digital camera, two videophones and an ISDN6 conferencing facility, in their ability to replicate colour and shape. The effects of uploading the images to a laptop computer and of transferring an image by MSN messaging are also evaluated. Part two provides an evaluation of electronic weighing scales connected via a wireless gateway to a landline telephone for the purpose of remote weight monitoring in patients with chronic heart failure. Self-reported experiences of patients, carers and specialist nurses are explored and outcomes compared with previously published opinion. The idiosyncratic nature of health care is highlighted as a main factor in the success or failure of the system. The third application is a patient-operated 12-lead ECG unit which transmits data via a home landline to a call centre, where it is displayed as an ECG trace and a report is given by specialist clinicians. Self-reported experiences of patients with arrhythmia reveal systematic phenomena which hinder the effectiveness of the device and which are related to human, not technological, failings. ECG traces obtained by unskilled lay persons on paediatric patients are compared with the ECG traces obtained by skilled and experienced paediatric nurses on the same patients. The results show that in the case of the cameraphones the technology is less accurate than normally assumed. In the case of the weight monitoring and ECG equipment however it is more usually human factors which cause a disappointing outcome