17 GENERAL INTRODUCTION Dermatology home consultation The third type of store-and-forward digital dermatology consultation provided by the telemedicine organization is dermatology home consultation (Figure 1.3). Digital dermatology home consultation is a free-of-charge primary teledermatology service whereby patients with skin complaints take photographs with their own smartphone and directly exchange information with their GP. In this way, the patient stays at home and does not have to physically visit a GP practice. During the pandemic this also meant no risk of exposure to the coronavirus (SARS-CoV-2). In this modality, the patient receives an email from a GP(assistant) with a link to a structured and secured digital request. The patient opens the digital request, preferably on his/her smartphone or tablet, takes and uploads two to four images of the skin lesion, and completes a closed-ended questionnaire. In the digital request, the patient receives basic instructions on how to take high-quality images (take images which are sharp and have a clear contrast, use good lighting, use no flash, and do not zoom in). Thereafter, the patient sends the consultation request back to the GP. The GP evaluates the skin condition himself/herself, provides feedback to the patient, and saves the information recorded in the dermatology home consultation request (automatically) into his/her HIS. If necessary, the GP can convert the home consultation request into an additional teledermatology consultation for advice and diagnosis by a TD. The GP can choose to add only images taken by the patient, or to take additional photographs in the GP practice in presence of the patient and add these photographs just like the regular teledermatology consultation flow. COVID-19 PANDEMIC AND TELEDERMATOLOGY IMPLEMENTATION COMPLEXITY The COVID-19 pandemic has been a worldwide driver to use digital dermatology as a solution to unburden standard face-to-face dermatology care [24,31,32]. Simultaneously, there was an exponential growth in “teledermatology” publications in the first (2020) and second (2021) COVID-19 pandemic year (Figure 1.5). The number of “teledermatology” “teledermoscopy” and “teledermatoscopy” publications grew steadily before the pandemic (864 publications between 1995-2019) and almost doubled to 1540 publications by the end of 2022. 1
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