18 CHAPTER 1 Figure 1.5: The number of publications in PubMed with search query “teledermatology or teledermoscopy or teledermatoscopy” (September 2023). This large worldwide uptake of digital dermatology services during the COVID-19 pandemic contrasted sharply with the long history of slow adoption before. The limited adoption of digital dermatology services before the pandemic was probably caused by the fact that telemedicine services are complex and versatile health systems and challenges remained in the use of these services. Implementation of these services is challenging because it transcends the process of merely installing a technology tool or platform and involves interactions between various technological and social human system aspects and workflow changes [60-62]. These aspects include for example, the perceived ease of use or usefulness of the digital dermatology platform technology, serviceable equipment adapted to technology needs, adequate and up-to-date training, technological assistance and support of patients, GPs and dermatologists, integration of the service within the current workflow, interaction and communication between digital dermatology provider and GPs or dermatologists and among GPs and dermatologists, insurance eligibility, reimbursement of care, equipment costs, etc. [22,62-67]. Furthermore, all of these aspects are closely interrelated with each other, which means that modifications to one aspect will affect changes elsewhere. The digital dermatology services function most effectively when these social and technical components work together and are “jointly optimized” [68,69]. Understanding how the different interrelated components in the digital dermatology services are experienced by the GPs in their day-to-day work processes is essential to further improve the services to the needs of the GPs and for the sustainability of the service [70]. Therefore, to continuously apply digital dermatology services and to support the major challenges of healthcare delivery by these services, it is important to regularly evaluate the status of these services, how these services are used and experienced by stakeholders, and to examine their possible added value. More specifically, given the impact of sociotechnical factors on implementation success and use of these services, research on the facilitators and barriers GPs examine will give insight into which improvements are required
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