150 CHAPTER 7 GPs’ intentions of using the digital dermatology negatively. These platform-related issues should be taken into account by the telemedicine organization and might require technological improvements because GPs also reported about missing functionalities in our study. The human-computer interface should be specifically optimized based on the clinical information needs that teledermatologists and GPs have in the digital dermatology decision-making context. For example, the Ksyos digital dermatology platform does not verify whether the photograph’s quality is sufficient or whether the correct number of images are attached. As suggested by GPs in the open-ended questions, quality validation in the consultation platform is needed that allows patients and GPs to only send digital dermatology consultations when all photographs have been taken and uploaded and are with sufficient quality. Such a quality validation step on the platform could warn the user if the uploaded photographs are incomplete or of inadequate quality and could request the GP directly to retake the images. In addition, image quality checklists or guidelines for taking (dermoscopic) images implemented on the platform can instruct GPs and patients to take photographs with sufficient quality [46,47]. Furthermore, a study in the United States showed promising results with an automated machine learning algorithm that evaluates dermatology image quality and provides, if necessary, specific recommendations and guidance to patients about how to improve the quality of their images [48]. Su et al [49] launched a feedback algorithm with “smart phrases” that induces patients to retake images if the latest images were of insufficient quality. Such algorithms might also improve the quality of the submitted images in the Dutch digital dermatology platform over time. In our study, two-thirds (42/66, 64%) of the GPs agreed that the dermatology care provided through the digital dermatology platform was the same as that in an in-person dermatology visit, meaning that digital consultation could replace regular in-person consultation. This percentage is consistent with a telemedicine study in the United States, where 63% of the physicians responded that the web-based telemedicine quality of care during the pandemic was generally similar to that of in-person care [50]. However, the sociotechnical analysis in our study showed that GPs had different perspectives and reported divergent reasons for when and for which skin conditions and patients they can or cannot apply the digital dermatology service instead of an in-person visit. Furthermore, this variety in GPs’ answers about when they (think they can) apply the service suggest that it is not always clear to GPs which skin conditions are (not) suitable for a digital dermatology consultation. Training by the telemedicine organization and during GP education programs is needed to better instruct GPs when to use and not use the service. Most GPs in our study responded that they would use the telemedicine platform again (61/66, 92%) and would recommend the platform to a colleague (53/66, 80%). Studies in other countries also show high GP satisfaction with and acceptance levels for digital dermatology care [35,45]. GPs in our study responded that they learned from practical experience (after repeated use of the platform) and the teledermatologist provided
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